Provider Demographics
NPI:1750748273
Name:MORRIS, JEREMY CLARK (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CLARK
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 1:1600 GARTH BROOKS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7412
Mailing Address - Country:US
Mailing Address - Phone:405-578-5234
Mailing Address - Fax:
Practice Address - Street 1:1600 GARTH BROOKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7412
Practice Address - Country:US
Practice Address - Phone:405-578-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty