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General NPI Number Information
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NPI Number | 1164713806
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Entity Type | Individual
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Provider Name | MORRIS JOSE DE LEON ANDRINO DDS
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Gender | Male
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 2727 N GRANDVIEW BLVD STE 206
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City | WAUKESHA
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State | WI
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Zip | 53188-1671
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Country | US
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Telephone | 262-542-8402
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 N MAYFAIR RD SUITE 311
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City | WAUWATOSA
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State | WI
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Zip | 53222-3219
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60332
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7165
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License Number State | WI
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