Healthcare Provider Details

I. General information

NPI: 1407806789
Provider Name (Legal Business Name): BEVERLY T MORRIS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24201 MERIDIAN RD
GROSSE ILE MI
48138-2134
US

IV. Provider business mailing address

24201 MERIDIAN RD
GROSSE ILE MI
48138-2134
US

V. Phone/Fax

Practice location:
  • Phone: 734-692-0102
  • Fax: 734-692-1541
Mailing address:
  • Phone: 734-692-0102
  • Fax: 734-692-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA L. JUSTICE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 734-692-0102