Provider Demographics
NPI:1295100626
Name:MORRIS DENTAL CLINIC, PA
Entity type:Organization
Organization Name:MORRIS DENTAL CLINIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JERE
Authorized Official - Last Name:RAMBOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-589-2161
Mailing Address - Street 1:300 PARK ST E
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-1207
Mailing Address - Country:US
Mailing Address - Phone:320-274-8555
Mailing Address - Fax:
Practice Address - Street 1:300 PARK STREET EAST
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302
Practice Address - Country:US
Practice Address - Phone:320-274-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty