NPIMap

Organization Active NPI

Tony Porter, DDS, PA

  • General Practice Dentistry
  • Winston-Salem, NC
National Provider Identifier
1174580294
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TONY PORTER, DDS, PA
Practice address
3031 Lyndhurst Ave
Winston-Salem, NC 27103-4007
Phone
(336) 765-9154
Fax
(336) 765-9291
NPI assigned
May 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Royce Anthony Porter Jr., D.D.S.NPI 1174581367
Title
Dentist/President
Phone
(336) 765-9154

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3031 Lyndhurst Ave
Winston-Salem, NC 27103-4007

Mailing address

3031 Lyndhurst Ave
Winston-Salem, NC 27103-4007
Phone (336) 765-9154

Other identifiers 2

IdentifierTypeStateIssuer
8997012MedicaidNC
97012OtherNCBC/BS PROVIDER ID

National Provider Directory

National Provider Directory

Locations

3031 Lyndhurst Ave
Winston Salem, NC 27103
Phone (336) 765-9154

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174580294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-9154",
            "fax_number": "336-765-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 LYNDHURST AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271034007",
            "telephone_number": "336-765-9154",
            "fax_number": "336-765-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TONY PORTER, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "ROYCE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "336-765-9154",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8997012",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER ID",
            "identifier": "97012",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston-Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.