Healthcare Provider Details

I. General information

NPI: 1972655405
Provider Name (Legal Business Name): JEREMY MICHEAL MORRISON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 CABEZON BLVD SE SUITE 101-A
RIO RANCHO NM
87124
US

IV. Provider business mailing address

2401 CABEZON BLVD SE SUITE 101-A
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-8862
  • Fax: 505-896-1859
Mailing address:
  • Phone: 505-449-8428
  • Fax: 505-962-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD2365
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: