Healthcare Provider Details

I. General information

NPI: 1487497954
Provider Name (Legal Business Name): KENT MCKOWEN MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13353 HIGHWAY 73 STE A
GEISMAR LA
70734-3090
US

IV. Provider business mailing address

4409 SAINT MARY ST 13353 HWY 73 STE A GEISMAR, LA 70734
METAIRIE LA
70006-2027
US

V. Phone/Fax

Practice location:
  • Phone: 225-673-0000
  • Fax: 225-673-1807
Mailing address:
  • Phone: 225-673-0000
  • Fax: 225-673-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7841
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: