Provider Demographics
NPI:1700874005
Name:MORRIS, STEPHEN JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 PINE ST
Mailing Address - Street 2:PO BOX 1008
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-1008
Mailing Address - Country:US
Mailing Address - Phone:320-769-2050
Mailing Address - Fax:
Practice Address - Street 1:737 PINE ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-1008
Practice Address - Country:US
Practice Address - Phone:320-769-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78851223G0001X
MND78851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN676515700Medicaid