Provider Demographics
NPI:1164840740
Name:MORRIS, MALORIE K
Entity Type:Individual
Prefix:DR
First Name:MALORIE
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MALORIE
Other - Middle Name:K
Other - Last Name:BOHNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9449 MILL CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233
Mailing Address - Country:US
Mailing Address - Phone:618-615-1296
Mailing Address - Fax:
Practice Address - Street 1:9449 MILL CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233
Practice Address - Country:US
Practice Address - Phone:618-615-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist