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General NPI Number Information
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NPI Number | 1689628604
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Entity Type | Organization
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Legal Business Name | PORTER, MARTIN, SALMAN, P.A.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 94 BRICK RD WEST JERSEY MEDICAL PLAZA STE. 100
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City | MARLTON
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State | NJ
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Zip | 08053-2179
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Country | US
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Telephone | 856-596-9099
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Fax | 856-983-5946
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Provider Business Mailing Address
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Address Line | 94 BRICK RD WEST JERSEY MEDICAL PLAZA STE. 100
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City | MARLTON
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State | NJ
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Zip | 08053-2179
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Country | US
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Telephone | 856-596-9099
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Fax | 856-983-5946
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADFORD J. PORTER
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Credential | DDS
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Telephone | 856-596-9099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DI14482
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License Number State | NJ
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