Healthcare Provider Details

I. General information

NPI: 1487330957
Provider Name (Legal Business Name): PATRICIA PORTELA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 MORRIS PARK AVE
BRONX NY
10462-3715
US

IV. Provider business mailing address

1178 BROADWAY 3RD FLOOR #3028
NEW YORK NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 718-377-6453
  • Fax:
Mailing address:
  • Phone: 347-326-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: