Dr. Beau Porter, D.D.S.
Dentist in Edmond, OK. Individual provider (NPI-1).
NPI number1902242522
StatusActive
Last updated in NPPESNov 4, 2016
Details
- NPI
- 1902242522
- Entity type
- Individual (NPI-1)
- Name
- Dr. Beau Porter
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 22, 2013
- Last updated
- Nov 4, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 6507 | OK | Yes |
Practice location
1616 S BoulevardEdmond, OK 73013-5155
Phone 405-348-2641
Mailing address
1616 S BoulevardEdmond, OK 73013-5155
Phone 405-348-2641
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