Provider Demographics
NPI:1407986755
Name:MORRIS, THEODORE MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MARK
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 1:1664 QUEENS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-8835
Mailing Address - Country:US
Mailing Address - Phone:412-655-7332
Mailing Address - Fax:
Practice Address - Street 1:2580 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH PARK
Practice Address - State:PA
Practice Address - Zip Code:15129-8576
Practice Address - Country:US
Practice Address - Phone:412-831-0520
Practice Address - Fax:412-831-3107
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019755L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice