Provider Demographics
NPI:1467760769
Name:STEPHEN C MORRIS DDS PA
Entity Type:Organization
Organization Name:STEPHEN C MORRIS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-391-0273
Mailing Address - Street 1:5666 SEMINOLE BLVD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-7328
Mailing Address - Country:US
Mailing Address - Phone:727-391-0273
Mailing Address - Fax:727-391-1870
Practice Address - Street 1:5666 SEMINOLE BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-7328
Practice Address - Country:US
Practice Address - Phone:727-391-0273
Practice Address - Fax:727-391-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0010351261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT87526Medicare UPIN
FL60772Medicare PIN