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General NPI Number Information
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NPI Number | 1750636569
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Entity Type | Individual
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Provider Name | LORI BETH PORRAS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 4603 OLEANDER DR STE 3
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5738
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Country | US
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Telephone | 843-353-3319
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Fax | 843-353-3238
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Provider Business Mailing Address
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Address Line | 584 STARLIT WAY
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-4322
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Country | US
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Telephone | 954-383-3893
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 19624
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9567
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License Number State | SC
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