Healthcare Provider Details

I. General information

NPI: 1699405134
Provider Name (Legal Business Name): EMILY LOUISE PORCELLI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 SEVEN SPRINGS BLVD
TRINITY FL
34655-3628
US

IV. Provider business mailing address

2511 SEVEN SPRINGS BLVD
TRINITY FL
34655-3628
US

V. Phone/Fax

Practice location:
  • Phone: 727-382-3681
  • Fax:
Mailing address:
  • Phone: 727-382-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044092
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: