Provider Demographics
NPI:1033280995
Name:PORTNOY, AMY (RDH)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CENTRE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2454
Mailing Address - Country:US
Mailing Address - Phone:617-965-2440
Mailing Address - Fax:617-965-2423
Practice Address - Street 1:1400 CENTRE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2454
Practice Address - Country:US
Practice Address - Phone:617-965-2440
Practice Address - Fax:617-965-2423
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8395124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8395OtherMA STATE LICENSE #