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?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty