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General NPI Number Information
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NPI Number | 1376362541
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Entity Type | Organization
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Legal Business Name | PORTO ORTHODONTICS PLLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 3300 BEELINE RD
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City | HOLLAND
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State | MI
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Zip | 49424-9220
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Country | US
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Telephone | 616-392-1435
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 44TH ST SW STE 101
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City | GRANDVILLE
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State | MI
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Zip | 49418-2300
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Country | US
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Telephone | 616-743-6569
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST / OWNER
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Name | FELIPE PORTO
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Credential | DDS, MS, MSD
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Telephone | 616-743-6569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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