Healthcare Provider Details

I. General information

NPI: 1760531792
Provider Name (Legal Business Name): MARK STEVEN MORELOCK SR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DOTHAN ROAD
ABBEVILLE AL
36310
US

IV. Provider business mailing address

301 DOTHAN ROAD
ABBEVILLE AL
36310
US

V. Phone/Fax

Practice location:
  • Phone: 334-585-5400
  • Fax: 334-585-6800
Mailing address:
  • Phone: 334-585-5400
  • Fax: 334-585-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4109
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: