Provider Demographics
NPI:1194023473
Name:POOLE, MORRIS LEWIS (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:LEWIS
Last Name:POOLE
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1340 NORTH 600 EAST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:435-753-0462
Mailing Address - Fax:435-753-7011
Practice Address - Street 1:1340 NORTH 600 EAST
Practice Address - Street 2:SUITE #2
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-753-0462
Practice Address - Fax:435-753-7011
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7223759-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics