Healthcare Provider Details

I. General information

NPI: 1144256199
Provider Name (Legal Business Name): SHERRY D PORTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 817
FPO AE
09622-9998
US

IV. Provider business mailing address

PSC 817
FPO AE
09622
US

V. Phone/Fax

Practice location:
  • Phone: 340-099-9642
  • Fax:
Mailing address:
  • Phone: 340-099-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: