Healthcare Provider Details

I. General information

NPI: 1265361034
Provider Name (Legal Business Name): DEMETRIOS GEORGE MORRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

4937 DREAM DANCER DR NE
RIO RANCHO NM
87144-0851
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-3749
  • Fax:
Mailing address:
  • Phone: 505-659-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: