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General NPI Number Information
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NPI Number | 1326645888
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Entity Type | Individual
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Provider Name | WENDELL KEITH PORTER RDH
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Gender | Male
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 4206 LOWES DR
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City | TEMPLE
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State | TX
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Zip | 76502-3498
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Country | US
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Telephone | 254-778-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 7014 BELLA CHARCA PKWY
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City | NOLANVILLE
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State | TX
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Zip | 76559-4728
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Country | US
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Telephone | 254-415-8499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 10294
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License Number State | TX
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