Sonny Ray Porter, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

62067 Issued in KS

Practice address

311 N Campus Dr Ste 101
Garden City, KS 67846-6298

Phone

(620) 272-0100

Fax

(620) 271-0160

NPI assigned

Aug 6, 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 AZ

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

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.

• Southwest Oral & Maxillofacial Surgery LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Garden City, KS
  • NPI 1548432628
  NPD (past)
• Sonoma Oral & Facial Surgery, PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Gilbert, AZ
  • NPI 1477063881
  NPD (past)

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1669603759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7528 E PERALTA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852129724",
            "telephone_number": "909-646-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N CAMPUS DR STE 101",
            "city": "GARDEN CITY",
            "state": "KS",
            "postal_code": "678466298",
            "telephone_number": "620-272-0100",
            "fax_number": "620-271-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "SONNY",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-06",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KS",
            "license": "62067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Petz, LPC
• Julie Lan Pham
• Phillips Chiropractic, P.a.
• Plaza Medical Center, Inc
• Plaza Pharmacy, Inc
• Aimee Porterfield
• Prairie Sage Functional Medicine and Kinesiology LLC
• Prairieview Home Health, L.L.C.
• Prohealth Chiropractic Wellness Centers, PA
• Prohealth Chiropractic Wellness Centers, PA

• Oral and Maxillofacial Surgery (Dentist) in Garden City, KS
• Providers in Garden City, KS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.