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NPI Code Detail

MEDICARE: DR. ANDREW W PORTER DDS

MEDICARE: DR. ANDREW W PORTER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry4101LA

General Provider Information

NPI Number : 1902828148
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW W PORTER DDS
Provider Business Mailing Address
First Line : 2533 BERT KOUNS INDUSTRIAL LOOP
Second Line : SUITE 107
City : SHREVEPORT
State : LA
Zip : 71118-3158
Country : US
Telephone Number : 318-688-1040
Fax Number : 318-688-3039
Provider Business Practice Location Address
First Line : 2533 BERT KOUNS INDUSTRIAL LOOP
Second Line : SUITE 107
City : SHREVEPORT
State : LA
Zip : 71118-3158
Country : US
Telephone Number : 318-688-1040
Fax Number : 318-688-3039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ANDREW W PORTER DDS” Practice Location

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