MEDICARE: KARISSA GALAVIZ-MORRIS

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	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1720586142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA GALAVIZ-MORRIS

Provider Business Mailing Address
First Line	:	6563 HAMPTON PL APT 2
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-2333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6563 HAMPTON PL APT 2
Second Line	:
City	:	FORT RILEY
State	:	KS
Zip	:	66442-2333
Country	:	US
Telephone Number	:	520-705-1054
Fax Number	:

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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