MEDICARE: BEVERLY T MORRIS DDS 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407806789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY T MORRIS DDS PC

Provider Business Mailing Address
First Line	:	24201 MERIDIAN RD
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-2134
Country	:	US
Telephone Number	:	734-692-0102
Fax Number	:	734-692-1541

Provider Business Practice Location Address
First Line	:	24201 MERIDIAN RD
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-2134
Country	:	US
Telephone Number	:	734-692-0102
Fax Number	:	734-692-1541

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. ANGELA L. JUSTICE
Credential	:
Telephone Number	:	734-692-0102

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/16/2011

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