Dr. Bradley Thain Porter
Oral and Maxillofacial Surgeon
6755 E Superstition Springs Blvd Suite 103
Mesa
, Arizona 85206-4373
Dr. Bradley Thain Porter
Oral and Maxillofacial Surgeon
6755 E Superstition Springs Blvd Suite 103
Mesa
, Arizona 85206-4373
(480) 807-0606
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Bradley Thain Porter
- 6755 E Superstition Springs Blvd Suite 103
- Mesa, AZ
- Zip : 85206-4373
- Fax : (480) 807-0606
- Phone : (480) 830-5866
Second Address
- Dr. Bradley Thain Porter
- 6755 E Superstition Springs Blvd Suite 103
- Mesa, AZ
- Zip : 85206-4373
- Fax : (480) 807-0606
- Phone : (480) 830-5866
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4124 | AZ |
National Provider Identifier
| NPI | 1023095734 |
|---|---|
| Provider Name | Dr. Bradley Thain Porter |
| First Address | Mesa, AZ 85206-4373 |
| Second Address | Mesa, AZ 85206-4373 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 23/12/2005 |
| Last Update Date | 04/12/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2173766 | (05) | AZ |
| AZ0482170 | BCBS (01) | AZ |
| U17636 | (02) | AZ |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.