Healthcare Provider Details

I. General information

NPI: 1437313079
Provider Name (Legal Business Name): MICAH L PORTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 PRESTON RD STE 200
FRISCO TX
75034-6575
US

IV. Provider business mailing address

6340 PRESTON RD STE 200
FRISCO TX
75034-6575
US

V. Phone/Fax

Practice location:
  • Phone: 469-633-9929
  • Fax: 469-633-1909
Mailing address:
  • Phone: 469-633-9929
  • Fax: 469-633-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number24351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: