Provider Demographics
NPI:1033245360
Name:MORRIS, KENNETH WAYNE (DDS03)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DDS03
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:604 N THOMAS ST
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0599
Mailing Address - Country:US
Mailing Address - Phone:434-447-4464
Mailing Address - Fax:434-447-2249
Practice Address - Street 1:604 NORTH THOMAS ST .
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-0599
Practice Address - Country:US
Practice Address - Phone:434-447-4464
Practice Address - Fax:434-447-2249
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010033961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice