Healthcare Provider Details

I. General information

NPI: 1578645024
Provider Name (Legal Business Name): BOBBY MORRISON DDS & BARRY PENDERGRASS DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 RAY MORRISON DR
CENTERVILLE TN
37033-3000
US

IV. Provider business mailing address

1824 RAY MORRISON DR
CENTERVILLE TN
37033-3000
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-3356
  • Fax: 931-729-7778
Mailing address:
  • Phone: 931-729-3356
  • Fax: 931-729-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS3110
License Number StateTN

VIII. Authorized Official

Name: BOBBY R MORRISON
Title or Position: MEMBER
Credential: DDS
Phone: 931-729-3356