Healthcare Provider Details

I. General information

NPI: 1285086355
Provider Name (Legal Business Name): MORRISON ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 E MURRAY HOLLADAY RD
SALT LAKE CITY UT
84117-5132
US

IV. Provider business mailing address

378 S 1350 W
FARMINGTON UT
84025-4745
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-7272
  • Fax:
Mailing address:
  • Phone: 402-595-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22041309922
License Number StateUT

VIII. Authorized Official

Name: DR. MICHAEL W MORRISON
Title or Position: OWNER
Credential: DDS, MSD
Phone: 801-278-7272