Provider Demographics
NPI:1518209816
Name:MORRIS, MATTIE MARIE (RDH, BSDH)
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 E ELLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1706
Mailing Address - Country:US
Mailing Address - Phone:503-580-2152
Mailing Address - Fax:
Practice Address - Street 1:7615 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2436
Practice Address - Country:US
Practice Address - Phone:503-244-3712
Practice Address - Fax:503-244-2122
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5888124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist