NPIMap

Organization Active NPI

Porter, Martin, Salman, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Marlton, NJ
National Provider Identifier
1689628604
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DI14482 Issued in NJ
Legal business name
PORTER, MARTIN, SALMAN, P.A.
Practice address
94 Brick Rd
West Jersey Medical Plaza Ste. 100
Marlton, NJ 08053-2179
Phone
(856) 596-9099
Fax
(856) 983-5946
NPI assigned
May 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Authorized official

Name
Dr. Bradford J. Porter, DDSNPI 1619965407
Title
President
Phone
(856) 596-9099

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
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X DI14482 NJ Primary

Addresses

Primary practice location

94 Brick Rd
West Jersey Medical Plaza Ste. 100
Marlton, NJ 08053-2179

Mailing address

94 Brick Rd
West Jersey Medical Plaza Ste. 100
Marlton, NJ 08053-2179
Phone (856) 596-9099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050629000621 NJ Part B Supplier - Clinic/Group Practice 0042256174 Receives reassigned benefits from 5 practitioners
Practice locations: Haddonfield, NJ; Marlton, NJ; Moorestown, NJ

National Provider Directory

National Provider Directory

Locations

195 N Haddon Ave
Haddonfield, NJ 08033
Phone (609) 429-9097

94 Brick Rd
Ste 100
Marlton, NJ 08053
Phone (856) 596-9099

Practitioners & affiliated clinicians

Practitioners 6

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": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471305600000",
    "number": "1689628604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 BRICK RD",
            "address_2": "WEST JERSEY MEDICAL PLAZA STE. 100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532179",
            "telephone_number": "856-596-9099",
            "fax_number": "856-983-5946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 BRICK RD",
            "address_2": "WEST JERSEY MEDICAL PLAZA STE. 100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532179",
            "telephone_number": "856-596-9099",
            "fax_number": "856-983-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTER, MARTIN, SALMAN, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2016-08-16",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-596-9099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI14482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.