Provider Demographics
NPI:1144256199
Name:PORTER, SHERRY D (RDH)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:D
Last Name:PORTER
Suffix:
Gender:F
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:PSC 817
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09622
Mailing Address - Country:US
Mailing Address - Phone:340-099-9642
Mailing Address - Fax:
Practice Address - Street 1:PSC 817
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09622-9998
Practice Address - Country:US
Practice Address - Phone:340-099-9642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11761124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist