Provider Demographics
NPI:1912074634
Name:MORRIS, ROBERT JACKSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JACKSON
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4347
Mailing Address - Country:US
Mailing Address - Phone:843-884-5161
Mailing Address - Fax:843-884-6585
Practice Address - Street 1:211 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4347
Practice Address - Country:US
Practice Address - Phone:843-884-5161
Practice Address - Fax:843-884-6585
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice