Provider Demographics
NPI:1225125149
Name:MORFORD, DAVID MALLORY (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MALLORY
Last Name:MORFORD
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 1:3903 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104
Mailing Address - Country:US
Mailing Address - Phone:304-424-7343
Mailing Address - Fax:304-424-7373
Practice Address - Street 1:3903 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104
Practice Address - Country:US
Practice Address - Phone:304-424-7343
Practice Address - Fax:304-424-7373
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist