Healthcare Provider Details

I. General information

NPI: 1265516553
Provider Name (Legal Business Name): DENNIS PAUL MORRIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DENNIS PAUL MORRIS DDS

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 W 95TH ST
OAK LAWN IL
60453-2255
US

IV. Provider business mailing address

13395 SHADOW CREEK DRIVE
PALOS HEIGHTS IL
60463
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-4300
  • Fax: 708-425-4310
Mailing address:
  • Phone: 708-389-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019-15088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: