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General NPI Number Information
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NPI Number | 1770750887
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Entity Type | Organization
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Legal Business Name | STEPHEN A. MORRIS
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 140 E BOISE AVE SUITE B
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City | BOISE
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State | ID
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Zip | 83706-4373
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Country | US
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Telephone | 208-344-4334
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Fax | 208-381-0450
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Provider Business Mailing Address
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Address Line | 140 E BOISE AVE STE B
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City | BOISE
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State | ID
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Zip | 83706-4374
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Country | US
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Telephone | 208-344-4334
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Fax | 208-381-0450
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN A. MORRIS
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Credential | D.D.S. M.S.
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Telephone | 208-344-4334
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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 | D-1998-OR
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License Number State | ID
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