Provider Demographics
NPI:1669644530
Name:TIMOTHY A MORRIS DDS INC
Entity Type:Organization
Organization Name:TIMOTHY A MORRIS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-455-7613
Mailing Address - Street 1:2223 FULTON RD NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3554
Mailing Address - Country:US
Mailing Address - Phone:330-455-7613
Mailing Address - Fax:330-455-1920
Practice Address - Street 1:2223 FULTON RD NW
Practice Address - Street 2:SUITE 201
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3554
Practice Address - Country:US
Practice Address - Phone:330-455-7613
Practice Address - Fax:330-455-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0666131Medicaid