Provider Demographics
NPI:1770604738
Name:MORRIS, WILLIAM EDWIN JR (DDS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWIN
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 SOUTH PARK TERRACE
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-9351
Mailing Address - Country:US
Mailing Address - Phone:336-627-5206
Mailing Address - Fax:336-623-5471
Practice Address - Street 1:114 SOUTH PARK TERRACE
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-9351
Practice Address - Country:US
Practice Address - Phone:336-627-5206
Practice Address - Fax:336-623-5471
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6748122300000X
NC4576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996209Medicaid