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General NPI Number Information
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NPI Number | 1679016414
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Entity Type | Organization
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Legal Business Name | MORRIS ORTHODONTICS PLLC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 1213C US HIGHWAY 491
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City | GALLUP
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State | NM
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Zip | 87301-4820
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Country | US
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Telephone | 505-979-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 E WILLOW TREE CT
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City | GILBERT
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State | AZ
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Zip | 85234-4932
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Country | US
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Telephone | 480-452-5134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MELVIN MORRIS
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Credential | DDS
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Telephone | 480-452-5134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DD3609
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License Number State | NM
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