Provider Demographics
NPI:1578645024
Name:BOBBY MORRISON DDS & BARRY PENDERGRASS DDS, PLLC
Entity Type:Organization
Organization Name:BOBBY MORRISON DDS & BARRY PENDERGRASS DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-729-3356
Mailing Address - Street 1:1824 RAY MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-3000
Mailing Address - Country:US
Mailing Address - Phone:931-729-3356
Mailing Address - Fax:931-729-7778
Practice Address - Street 1:1824 RAY MORRISON DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-3000
Practice Address - Country:US
Practice Address - Phone:931-729-3356
Practice Address - Fax:931-729-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0005166OtherTENNCARE PROVIDER #