Provider Demographics
NPI:1942303409
Name:MORRIS, PATRICK J (PERIODONTIST)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PERIODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64056
Mailing Address - Country:US
Mailing Address - Phone:816-554-2663
Mailing Address - Fax:816-554-2664
Practice Address - Street 1:613 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64056
Practice Address - Country:US
Practice Address - Phone:816-554-2663
Practice Address - Fax:816-554-2664
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015523122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist