Most Relevant Information
Provider Data
| NPI Number: | 1003272444 |
| Provider Name: | JASON PORTER |
| Entity Type: | Individual |
| Taxonomy Code: | 1223X0400X |
| Specialty: | Dentist |
| License Number: | 0442000250 |
Most Important Dates
| Enumeration Date: | 01/14/2016 |
| Last Updated: | 05/22/2019 |
Provider Practice Location
1721 E LINCOLN AVE
SUNNYSIDE
WA
989442478
Practice Location Phone/Fax
| Phone: | 5098377178 |
| Fax: | 5098373117 |
Provider Mailing Location
1721 E LINCOLN AVE
SUNNYSIDE
WA
989442478
Provider Mailing Phone/Fax
| Phone: | 5098371778 |
| Fax: | 5098373117 |