Provider Demographics
NPI:1578811519
Name:R GLENN MORRIS DDS INC
Entity Type:Organization
Organization Name:R GLENN MORRIS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-697-2631
Mailing Address - Street 1:5990 AIRLINE DR
Mailing Address - Street 2:SUITE100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4233
Mailing Address - Country:US
Mailing Address - Phone:713-697-2631
Mailing Address - Fax:713-697-2046
Practice Address - Street 1:5990 AIRLINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4233
Practice Address - Country:US
Practice Address - Phone:713-697-2631
Practice Address - Fax:713-697-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92411223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008462601Medicaid