Healthcare Provider Details

I. General information

NPI: 1326026410
Provider Name (Legal Business Name): MORRIS JOSEPH SORIANO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CANTON RD SUITE 3
MARIETTA GA
30066-2739
US

IV. Provider business mailing address

130 LARNE CT
ROSWELL GA
30076-4446
US

V. Phone/Fax

Practice location:
  • Phone: 770-926-4333
  • Fax: 770-926-0033
Mailing address:
  • Phone: 770-992-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: