Provider Demographics
NPI:1407176704
Name:MORRIS, JOHN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 VIRGINIA ST E APT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2190
Mailing Address - Country:US
Mailing Address - Phone:805-291-2974
Mailing Address - Fax:
Practice Address - Street 1:415 MORRIS ST STE 309
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1853
Practice Address - Country:US
Practice Address - Phone:304-388-3290
Practice Address - Fax:304-388-3186
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV41971223G0001X
ORD95831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice