Provider Demographics
NPI:1619412897
Name:MORRIS, JORDAN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18726 S NOGALES HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5878
Mailing Address - Country:US
Mailing Address - Phone:520-625-4850
Mailing Address - Fax:
Practice Address - Street 1:18726 S NOGALES HWY
Practice Address - Street 2:STE 100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5878
Practice Address - Country:US
Practice Address - Phone:520-625-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009634122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist