Provider Demographics
NPI:1740202969
Name:MORRIS, GEORGE EDWARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3238
Mailing Address - Country:US
Mailing Address - Phone:708-798-4730
Mailing Address - Fax:708-798-4963
Practice Address - Street 1:2158 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3238
Practice Address - Country:US
Practice Address - Phone:708-798-4730
Practice Address - Fax:708-798-4963
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190192891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL28171OtherBCBS OF IL PROVIDER #
IL019019289Medicaid
ILU17923Medicare UPIN
IL019019289Medicaid