Active NPI
Raymond Eugene Porco Jr., DDS
- Dentist
- Montgomery, AL
National Provider Identifier
1083794754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD5131
- Practice address
- 755 E South Blvd
Montgomery, AL 36116 - Phone
- (334) 495-2243
- Fax
- (334) 495-2244
- NPI assigned
- Oct 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | DD5131 | AL | Primary |
Addresses
Primary practice location
755 E South Blvd
Montgomery, AL 36116
Mailing address
6257 Monticello Cove
Montgomery, AL 36117
Phone (334) 213-0716
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 |
|---|---|---|---|
| DD5131 | AL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alabama Smiles | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083794754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6257 MONTICELLO COVE",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "36117",
"telephone_number": "334-213-0716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 E SOUTH BLVD",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "36116",
"telephone_number": "334-495-2243",
"fax_number": "334-495-2244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORCO",
"first_name": "RAYMOND",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "DD5131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.