Provider Demographics
NPI:1285011098
Name:JOHN M MORRIS DDS PLLC
Entity Type:Organization
Organization Name:JOHN M MORRIS DDS PLLC
Other - Org Name:HOLLYWOOD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-636-9970
Mailing Address - Street 1:1445 W SOUTHERN AVE
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4803
Mailing Address - Country:US
Mailing Address - Phone:480-636-9970
Mailing Address - Fax:
Practice Address - Street 1:1445 W SOUTHERN AVE
Practice Address - Street 2:SUITE 1212
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4803
Practice Address - Country:US
Practice Address - Phone:480-636-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0080501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty