Provider Demographics
NPI:1730197880
Name:PORTEN, BARRY L (DDS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:PORTEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 BUSTLETON AVE
Mailing Address - Street 2:205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3313
Mailing Address - Country:US
Mailing Address - Phone:215-698-6622
Mailing Address - Fax:215-698-6655
Practice Address - Street 1:10890 BUSTLETON AVE
Practice Address - Street 2:205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3313
Practice Address - Country:US
Practice Address - Phone:215-698-6622
Practice Address - Fax:215-698-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21565L122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics