Healthcare Provider Details

I. General information

NPI: 1659648541
Provider Name (Legal Business Name): HEATHER CULLEEN GREEN-MORRISON D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12125 SHAWNEE MISSION PKWY
SHAWNEE KS
66216-1829
US

IV. Provider business mailing address

12810 W 119TH TER
OVERLAND PARK KS
66213-2374
US

V. Phone/Fax

Practice location:
  • Phone: 913-469-9191
  • Fax:
Mailing address:
  • Phone: 312-493-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number61059
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number054801
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2014034197
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: