Provider Demographics
NPI:1902967524
Name:SHAD L MORRIS DMD PC
Entity Type:Organization
Organization Name:SHAD L MORRIS DMD PC
Other - Org Name:PREMIER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-586-6526
Mailing Address - Street 1:427 S MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720
Mailing Address - Country:US
Mailing Address - Phone:435-586-6526
Mailing Address - Fax:435-867-9203
Practice Address - Street 1:427 S MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-586-6526
Practice Address - Fax:435-867-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT02800149922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS29980447007Medicaid
UT02800149900001OtherBLUE CROSS BLUE SHIELD