Provider Demographics
NPI:1255535043
Name:TODD J. MORTON DMD, PC
Entity type:Organization
Organization Name:TODD J. MORTON DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-227-5422
Mailing Address - Street 1:485 WILDWOOD PARKWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:636-227-5422
Mailing Address - Fax:636-227-4992
Practice Address - Street 1:485 WILDWOOD PARKWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011
Practice Address - Country:US
Practice Address - Phone:636-227-5422
Practice Address - Fax:636-227-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0154341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty