Provider Demographics
NPI:1760430912
Name:PATRICK W MORRISSEY DDS LLC
Entity Type:Organization
Organization Name:PATRICK W MORRISSEY DDS LLC
Other - Org Name:BOONES FERRY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-699-6699
Mailing Address - Street 1:17437 SW BOONES FERRY ROAD
Mailing Address - Street 2:BUILDING B SUITE 400
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-699-6699
Mailing Address - Fax:503-699-7676
Practice Address - Street 1:17437 SW BOONES FERRY ROAD
Practice Address - Street 2:BUILDING B SUITE 400
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-699-6699
Practice Address - Fax:503-699-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty