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General NPI Number Information
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NPI Number | 1396324356
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Entity Type | Individual
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Provider Name | GELISE MARIE PORTER DDS
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Gender | Female
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 2807 W THOMAS ST
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City | HAMMOND
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State | LA
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Zip | 70401-2840
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Country | US
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Telephone | 985-602-2716
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Fax |
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Provider Business Mailing Address
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Address Line | 705 JEFFERSON ST UNIT 114
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City | LAFAYETTE
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State | LA
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Zip | 70501-6937
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Country | US
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Telephone | 318-730-3539
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38855
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7249
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License Number State | LA
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