Provider Demographics
NPI:1538045455
Name:PORT, KATIE (RDH,IPDH)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:PORT
Suffix:
Gender:F
Credentials:RDH,IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HALLOWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-1126
Mailing Address - Country:US
Mailing Address - Phone:207-441-2506
Mailing Address - Fax:
Practice Address - Street 1:68 BEN PAUL LN
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4452
Practice Address - Country:US
Practice Address - Phone:207-441-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3073124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist