Provider Demographics
NPI:1609801471
Name:MORTON, DOUGLAS SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:MORTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:SCOTT
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:881 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3615
Mailing Address - Country:US
Mailing Address - Phone:805-543-2887
Mailing Address - Fax:805-543-0129
Practice Address - Street 1:881 PACIFIC STREET
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3615
Practice Address - Country:US
Practice Address - Phone:805-543-2887
Practice Address - Fax:805-543-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice