Irivelisse Stevens Porter, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19714 Issued in FL

Practice address

12086 Fort Caroline Rd
Suite 105
Jacksonville, FL 32225-2687

Phone

(904) 807-9127

NPI assigned

Jul 19, 2012

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

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.

• Hidden Hills Family Dentistry

  • Dentist
  • Jacksonville, FL
  • NPI 1871647255
  NPD (past)

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1407101033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5077 CREEK CROSSING DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322264779",
            "telephone_number": "904-463-4531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12086 FORT CAROLINE RD",
            "address_2": "SUITE 105",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252687",
            "telephone_number": "904-807-9127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "IRIVELISSE",
        "middle_name": "STEVENS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "19714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abby Porter, ARNP
• Amanda Lee Porter, DC
• Brandon Emil Porter, PHARMD
• Burgess Devone Porter II
• Candace Porter, LCSW
• Ivan Porter, MD
• Misty D Porter, B.A.
• Phyllis Diane Porter
• Shimol Porter
• Steven Porter, MD

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; 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.