Provider Demographics
NPI:1982881413
Name:MORRISON, KELLY SUSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SUSAN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3160
Mailing Address - Country:US
Mailing Address - Phone:203-272-0900
Mailing Address - Fax:203-271-2300
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3160
Practice Address - Country:US
Practice Address - Phone:203-272-0900
Practice Address - Fax:203-271-2300
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT95841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics