Provider Demographics
NPI:1013740752
Name:DORRIS, DACIA RAE
Entity type:Individual
Prefix:
First Name:DACIA
Middle Name:RAE
Last Name:DORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-4439
Mailing Address - Country:US
Mailing Address - Phone:918-337-8080
Mailing Address - Fax:
Practice Address - Street 1:705 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4439
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist