Provider Demographics
NPI:1649322819
Name:MORRIS, JAN ALICE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:ALICE
Last Name:MORRIS
Suffix:
Gender:F
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:PO BOX 989
Mailing Address - Street 2:4012 RR 1431
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-0989
Mailing Address - Country:US
Mailing Address - Phone:325-388-4694
Mailing Address - Fax:325-388-4694
Practice Address - Street 1:4012 W RANCH ROAD 1431
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-3253
Practice Address - Country:US
Practice Address - Phone:325-388-4694
Practice Address - Fax:325-388-4694
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist