Provider Demographics
NPI:1053851345
Name:MORRIS, RENETTRA ANGELE (DDS)
Entity Type:Individual
Prefix:
First Name:RENETTRA
Middle Name:ANGELE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560
Mailing Address - Country:US
Mailing Address - Phone:310-930-8363
Mailing Address - Fax:
Practice Address - Street 1:101 WEST COAST RD. #A
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560-1633
Practice Address - Country:US
Practice Address - Phone:707-923-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist