MEDICARE: MS. ANNE MARIE MORRIS RDH

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	124Q00000X	Dental Hygienist	H3226	OR

General Provider Information

NPI Number	:	1467670406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE MARIE MORRIS RDH

Provider Business Mailing Address
First Line	:	16127 NW ENERGIA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-9249
Country	:	US
Telephone Number	:	503-439-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	5935 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-1925
Country	:	US
Telephone Number	:	503-234-1218
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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