Provider Demographics
NPI:1114040086
Name:MORRISON, MARSHALL W JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:W
Last Name:MORRISON
Suffix:JR
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 1:4237 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1207
Mailing Address - Country:US
Mailing Address - Phone:757-340-1232
Mailing Address - Fax:757-431-4695
Practice Address - Street 1:4237 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1207
Practice Address - Country:US
Practice Address - Phone:757-340-1232
Practice Address - Fax:757-431-4695
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA76141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice