MEDICARE: MRS. MADELYN GAY MORRIS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401411163	VA

General Provider Information

NPI Number	:	1134237613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELYN GAY MORRIS DDS

Provider Business Mailing Address
First Line	:	3107 HUNGARY SPRING RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228
Country	:	US
Telephone Number	:	804-501-0501
Fax Number	:	804-501-0509

Provider Business Practice Location Address
First Line	:	3107 HUNGARY SPRING RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228
Country	:	US
Telephone Number	:	804-501-0501
Fax Number	:	804-501-0509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	06/22/2021

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