Healthcare Provider Details

I. General information

NPI: 1578811519
Provider Name (Legal Business Name): R GLENN MORRIS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 AIRLINE DR SUITE 100
HOUSTON TX
77076-4233
US

IV. Provider business mailing address

5990 AIRLINE DR SUITE100
HOUSTON TX
77076-4233
US

V. Phone/Fax

Practice location:
  • Phone: 713-697-2631
  • Fax: 713-697-2046
Mailing address:
  • Phone: 713-697-2631
  • Fax: 713-697-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number9241
License Number StateTX

VIII. Authorized Official

Name: ROBERT GLENN MORRIS
Title or Position: OWNER
Credential: DDS
Phone: 713-697-2631