Provider Demographics
NPI:1265715262
Name:POOLE, MORRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:
Last Name:POOLE
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 1:1429 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3711
Mailing Address - Country:US
Mailing Address - Phone:713-529-6071
Mailing Address - Fax:713-529-3626
Practice Address - Street 1:1427 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3711
Practice Address - Country:US
Practice Address - Phone:713-341-3790
Practice Address - Fax:713-524-7995
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077190-01Medicaid