=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104945377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY B MORRIS D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 N WILLOW ST STE 1
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89027-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-346-2882
-----------------------------------------------------
Fax | 702-346-8714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 N WILLOW ST STE 1
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89027-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-346-2882
-----------------------------------------------------
Fax | 702-346-8714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 1031
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------