Kevin E Porter, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

16990 Issued in TX

Practice address

8101 Dorado Dr
Odessa, TX 79765-8533

Phone

(432) 333-6585

Fax

(432) 333-9346

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 15, 2012 through May 15, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Permian Basin Oral Surgery & Dental Implant Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Odessa, TX
  • NPI 1922288539
  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1225181746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8101 DORADO DR",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658533",
            "telephone_number": "432-333-6585",
            "fax_number": "432-333-9346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8101 DORADO DR",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658533",
            "telephone_number": "432-333-6585",
            "fax_number": "432-333-9346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "KEVIN",
        "middle_name": "E",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "16990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tandi Leigh Poitevint, M.S.,CCC/SLP
• James Harold Pollard, OTR
• Jolie Suzanne Pollard, MS,CCC/SLP
• Dustin Pool, PHARM D
• Theresia Pope
• Positive Change Therapy, PLLC
• Ryan Post
• Simran Pradhan
• Andrew Prado, PHARMD
• Megan Prado, PHARMD

• Oral and Maxillofacial Surgery (Dentist) in Odessa, TX
• Providers in Odessa, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.