Provider Demographics
NPI:1679016414
Name:MORRIS ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:MORRIS ORTHODONTICS PLLC
Other - Org Name:HOLLYWOOD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-452-5134
Mailing Address - Street 1:1910 E WILLOW TREE CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4932
Mailing Address - Country:US
Mailing Address - Phone:480-452-5134
Mailing Address - Fax:
Practice Address - Street 1:1213C US HIGHWAY 491
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4820
Practice Address - Country:US
Practice Address - Phone:505-979-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD36091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty