Porter, Brent Joseph

Porter, Brent Joseph is an sole proprietor health care provider with primary practice located at 550 Water St Suite D, Number 1, Santa Cruz CA 95060-4124. He recently has 3 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry, Dental Providers / Orthodontics and Dentofacial Orthopedics. Dental Providers / General Practice is his primary health care specialty. Porter, Brent Joseph can be contacted via phone (831) 459-9802.

Contact Information

Primary practice address
550 Water St Suite D, Number 1 Santa Cruz CA 95060-4124
Phone: (831) 459-9802
Fax: (831) 459-8234
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 39322 California
Dental Providers / Pediatric Dentistry 1223P0221X 39322 California
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 39322 California

Profile Details

NPI number 1134331887
LBN Legal business name Porter, Brent Joseph
Credentials D.D.S., M.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 4th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134331887 NPPES
California Other B39322 DENTI-CAL

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