Provider Demographics
NPI: | 1174188510 |
---|---|
Name: | DARRYL L. MORRIS A PROFESSIONAL CORPORATION |
Entity Type: | Organization |
Organization Name: | DARRYL L. MORRIS A PROFESSIONAL CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | BRITTANY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BRUNNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RDA |
Authorized Official - Phone: | 909-481-9500 |
Mailing Address - Street 1: | 10165 FOOTHILL BLVD STE 23 |
Mailing Address - Street 2: | |
Mailing Address - City: | RANCHO CUCAMONGA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91730-0342 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-481-9500 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10165 FOOTHILL BLVD STE 23 |
Practice Address - Street 2: | |
Practice Address - City: | RANCHO CUCAMONGA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91730-0342 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-481-9500 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-05-01 |
Last Update Date: | 2019-05-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223S0112X | Dental Providers | Dentist | Oral and Maxillofacial Surgery | Group - Single Specialty |