Provider Demographics
NPI:1114104775
Name:MORRISON, WENDELL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:S
Last Name:MORRISON
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 1:1680 DUNN AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4782
Mailing Address - Country:US
Mailing Address - Phone:904-696-6767
Mailing Address - Fax:
Practice Address - Street 1:1680 DUNN AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4782
Practice Address - Country:US
Practice Address - Phone:904-696-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice