Healthcare Provider Details

I. General information

NPI: 1376586321
Provider Name (Legal Business Name): HARRIS LIONEL PORET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 LEVEE RD
SAINT JOSEPH LA
71366-6639
US

IV. Provider business mailing address

1115 LEVEE RD P.O. BOX 46
SAINT JOSEPH LA
71366-6639
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-1967
  • Fax: 318-766-9090
Mailing address:
  • Phone: 318-766-1967
  • Fax: 318-766-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1594
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: