=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740343979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRISON DENTAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 05/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1524 ROUTE 9
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-8646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-371-3400
-----------------------------------------------------
Fax | 518-371-9058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1524 ROUTE 9
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-8646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-371-3400
-----------------------------------------------------
Fax | 518-371-9058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. DAVID PAUL MORRISON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 518-371-3400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 054105
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------