Provider Demographics
NPI:1760472609
Name:FRIST, MORRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MORRY
Middle Name:
Last Name:FRIST
Suffix:
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 1:21 TAFT CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4139
Mailing Address - Country:US
Mailing Address - Phone:718-698-8353
Mailing Address - Fax:
Practice Address - Street 1:87 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6628
Practice Address - Country:US
Practice Address - Phone:718-387-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0332141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice