Provider Demographics
NPI:1093737421
Name:MORRILL, BRENT K (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:K
Last Name:MORRILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 WESTWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-1281
Mailing Address - Country:US
Mailing Address - Phone:719-686-8255
Mailing Address - Fax:719-687-2313
Practice Address - Street 1:451 RAMPART RANGE RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80866
Practice Address - Country:US
Practice Address - Phone:719-687-3131
Practice Address - Fax:719-687-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice