=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245593094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN L MORRIS DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2012
-----------------------------------------------------
Last Update Date | 06/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 389 HUNTLEY PKWY
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124-6164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-664-5099
-----------------------------------------------------
Fax | 205-664-5097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 389 HUNTLEY PKWY
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124-6164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-664-5099
-----------------------------------------------------
Fax | 205-664-5097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KEVIN L MORRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-602-8660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5479
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------