Provider Demographics
NPI:1912275991
Name:MORRIS, JOHN MELVIN (DDS, DHSC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MELVIN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DDS, DHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 E DIAS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3834
Mailing Address - Country:US
Mailing Address - Phone:480-452-5134
Mailing Address - Fax:
Practice Address - Street 1:1757 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1533
Practice Address - Country:US
Practice Address - Phone:480-452-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80501223X0400X
NM36091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics