MEDICARE: DR WAYNE A MORS ORTHODONTIST PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		IL

General Provider Information

NPI Number	:	1174746226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR WAYNE A MORS ORTHODONTIST PC

Provider Business Mailing Address
First Line	:	4306 G W CRYSTAL LAKE ROAD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4274
Country	:	US
Telephone Number	:	815-344-4900
Fax Number	:	815-344-4907

Provider Business Practice Location Address
First Line	:	4306 G W CRYSTAL LAKE ROAD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4274
Country	:	US
Telephone Number	:	815-344-4900
Fax Number	:	815-344-4907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE A MORS
Credential	:	DDS
Telephone Number	:	815-344-4900

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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