Healthcare Provider Details

I. General information

NPI: 1649363490
Provider Name (Legal Business Name): JOSEPH M. MORELLI JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S. PRESTON ST. UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY
LOUISVILLE KY
40202-1701
US

IV. Provider business mailing address

501 S PRESTON ST UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY
LOUISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5128
  • Fax: 502-852-7163
Mailing address:
  • Phone: 502-852-5128
  • Fax: 502-852-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6774
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: