Healthcare Provider Details

I. General information

NPI: 1689760571
Provider Name (Legal Business Name): MORRISON DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BUCK ISLAND RD
BLUFFTON SC
29910-5936
US

IV. Provider business mailing address

15 BUCK ISLAND RD
BLUFFTON SC
29910-5936
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-2146
  • Fax: 843-706-2149
Mailing address:
  • Phone: 843-706-2146
  • Fax: 843-706-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4005
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3626
License Number StateSC

VIII. Authorized Official

Name: PATRIUCIA FITZSIMMONS
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-706-2146