Provider Demographics
NPI:1437258597
Name:MORRIS, TIMOTHY ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:MORRIS
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 1:2223 FULTON RD NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3554
Mailing Address - Country:US
Mailing Address - Phone:330-455-7613
Mailing Address - Fax:330-455-1920
Practice Address - Street 1:2223 FULTON RD NW
Practice Address - Street 2:SUITE 201
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3554
Practice Address - Country:US
Practice Address - Phone:330-455-7613
Practice Address - Fax:330-455-1920
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-08-06
Deactivation Date:2008-03-31
Deactivation Code:
Reactivation Date:2008-04-14
Provider Licenses
StateLicense IDTaxonomies
OH185641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0666131Medicaid