Bryan Neal Porter, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

7712105-9923 Issued in UT

Practice address

3125 N Main St
Suite #104
North Logan, UT 84341-1547

Phone

(435) 787-4444

Fax

(435) 787-0044

NPI assigned

Jul 23, 2009

Sex

Male

Sole proprietor

Yes

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

Enrolled in UT

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Hyde Park Dental

  • General Practice Dentistry
  • North Logan, UT
  • NPI 1922440031
  NPD (past)

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456963200000",
    "number": "1376773481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 N 600 E",
            "address_2": "STE 4",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412474",
            "telephone_number": "435-753-1690",
            "fax_number": "435-752-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 N MAIN ST",
            "address_2": "SUITE #104",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411547",
            "telephone_number": "435-787-4444",
            "fax_number": "435-787-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "BRYAN",
        "middle_name": "NEAL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-23",
        "last_updated": "2016-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "7712105-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaun M Petersen, PA
• Phil Rich Inc (LTC of Cache Valley)
• Philrich Inc (cache valley pharmacy)
• Philrich Inc (cache valley pharmacy)
• Samuel Harris Pond, LCSW
• Primary Care Pediatrics
• Jeffrey J Pulley, PA-C
• Robert S. Cook, PH.D., PC
• Glenn L Robertson, MD
• Zachary Robinett, M.D.

• Dentist in North Logan, UT
• Providers in North Logan, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.