Provider Demographics
NPI:1306841721
Name:MORISSE, REBECCA K (DMD)
Entity Type:Individual
Prefix:PROF
First Name:REBECCA
Middle Name:K
Last Name:MORISSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8422 SW TERWILLIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4549
Mailing Address - Country:US
Mailing Address - Phone:503-244-8243
Mailing Address - Fax:503-244-9293
Practice Address - Street 1:8422 SW TERWILLIGER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4549
Practice Address - Country:US
Practice Address - Phone:503-244-8243
Practice Address - Fax:503-244-9293
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD80691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice