Provider Demographics
NPI:1356116131
Name:MORRIS, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 NW 167TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4838
Mailing Address - Country:US
Mailing Address - Phone:305-474-1803
Mailing Address - Fax:786-629-3702
Practice Address - Street 1:1825 NW 167TH ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-474-1803
Practice Address - Fax:786-629-3702
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH10483124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty