Provider Demographics
NPI:1871730440
Name:PORTER, ZACK J (DDS)
Entity type:Individual
Prefix:DR
First Name:ZACK
Middle Name:J
Last Name:PORTER
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 1:2137 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3824
Mailing Address - Country:US
Mailing Address - Phone:541-389-4807
Mailing Address - Fax:541-385-6883
Practice Address - Street 1:2137 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3824
Practice Address - Country:US
Practice Address - Phone:541-389-4807
Practice Address - Fax:541-385-6883
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice