Provider Demographics
NPI:1164575676
Name:MORRISON, DANIEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:417 W FLYING CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4701
Mailing Address - Country:US
Mailing Address - Phone:307-682-3353
Mailing Address - Fax:307-687-2861
Practice Address - Street 1:417 W FLYING CIRCLE DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4701
Practice Address - Country:US
Practice Address - Phone:307-682-3353
Practice Address - Fax:307-687-2861
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8161223G0001X
WY1214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7803450Medicaid