=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669243028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN MORRISON DMD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2024
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 N 3RD ST
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35901-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-459-5309
-----------------------------------------------------
Fax | 256-459-5306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 268
-----------------------------------------------------
City | ATTALLA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35954-0268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-459-5309
-----------------------------------------------------
Fax | 256-459-5306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST OWNER
-----------------------------------------------------
Name | RYAN MORRISON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 256-459-5309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------