Healthcare Provider Details

I. General information

NPI: 1700201407
Provider Name (Legal Business Name): DENNIS P PORTO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UNIVERSITY AVE SUITE 230
WEST DES MOINES IA
50266-8203
US

IV. Provider business mailing address

6000 UNIVERSITY AVE SUITE 230
WEST DES MOINES IA
50266-8203
US

V. Phone/Fax

Practice location:
  • Phone: 515-222-0677
  • Fax: 515-222-0019
Mailing address:
  • Phone: 515-222-0677
  • Fax: 515-222-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number27404
License Number StateIA

VIII. Authorized Official

Name: DR. DENNIS PATRICK PORTO
Title or Position: OWNER
Credential: MD
Phone: 515-222-0677