MEDICARE: DR. THEODORE MARK MORRIS DMD

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	1223G0001X	General Practice Dentistry	DS019755L	PA

General Provider Information

NPI Number	:	1407986755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE MARK MORRIS DMD

Provider Business Mailing Address
First Line	:	1664 QUEENS DR
Second Line	:
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-8835
Country	:	US
Telephone Number	:	412-655-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 BROWNSVILLE RD
Second Line	:
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-8576
Country	:	US
Telephone Number	:	412-831-0520
Fax Number	:	412-831-3107

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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