Provider Demographics
NPI:1396896973
Name:MORRIS, SHAD L (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAD
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 E RIVERSIDE DR
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6758
Mailing Address - Country:US
Mailing Address - Phone:435-628-0621
Mailing Address - Fax:435-688-9528
Practice Address - Street 1:352 E RIVERSIDE DR
Practice Address - Street 2:SUITE C-1
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6758
Practice Address - Country:US
Practice Address - Phone:435-628-0621
Practice Address - Fax:435-688-9528
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT028001499221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice