MEDICARE: DR. PAUL RICHARD MORRISON JR. DDS

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	122300000X	Dentist	019028723	IL

General Provider Information

NPI Number	:	1194012773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL RICHARD MORRISON JR. DDS

Provider Business Mailing Address
First Line	:	1920 W SCHOOL ST
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-2035
Country	:	US
Telephone Number	:	856-981-1049
Fax Number	:

Provider Business Practice Location Address
First Line	:	3332 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6213
Country	:	US
Telephone Number	:	773-327-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	05/30/2012

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