Active NPI
Jeffrey Lee Porter, D.D.S.
- Dentist
- Charlevoix, MI
National Provider Identifier
1043488901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901009449
- Practice address
- 201 Bridge Park Drive
Charlevoix, MI 49720-1381 - Phone
- (231) 547-9516
- Fax
- (231) 547-9526
- NPI assigned
- Feb 13, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901009449 | MI | Primary |
Addresses
Primary practice location
201 Bridge Park Drive
Charlevoix, MI 49720-1381
Mailing address
201 Bridge Park Drive
Charlevoix, MI 49720
Phone (231) 547-9516
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901009449 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gentle Family Dentistry | Past | Accepting new patients | |
| Porter & Associates DDS PC | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Charlevoix, MI
- NPI 1326173659
-
- General Practice Dentistry
- Charlevoix, MI
- NPI 1679015507
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202860800000",
"number": "1043488901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 BRIDGE PARK DRIVE",
"city": "CHARLEVOIX",
"state": "MI",
"postal_code": "49720",
"telephone_number": "231-547-9516",
"fax_number": "231-547-9526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 BRIDGE PARK DRIVE",
"city": "CHARLEVOIX",
"state": "MI",
"postal_code": "497201381",
"telephone_number": "231-547-9516",
"fax_number": "231-547-9526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "JEFFREY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-13",
"last_updated": "2008-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901009449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlevoix, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.