Provider Demographics
NPI:1073683769
Name:MELVIN R MORRISON DDS LTD
Entity Type:Organization
Organization Name:MELVIN R MORRISON DDS LTD
Other - Org Name:MELVIN R MORRISON DDS LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER INSURANCE COORDINATO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:757-467-8000
Mailing Address - Street 1:204 MEDICAL TOWER
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1901
Mailing Address - Country:US
Mailing Address - Phone:757-467-8000
Mailing Address - Fax:757-467-9653
Practice Address - Street 1:204 MEDICAL TOWER
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1901
Practice Address - Country:US
Practice Address - Phone:757-467-8000
Practice Address - Fax:757-467-9653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELVIN R MORRISON DDS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401006550174400000X
VA401002480174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992730808OtherNPI
VA008011702Medicaid
VA1073683769OtherNPI
VA190000322Medicare PIN
VA1073683769OtherNPI