Provider Demographics
NPI:1144364506
Name:MORRISON, STANLEY E (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:MORRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-3738
Mailing Address - Country:US
Mailing Address - Phone:618-548-5808
Mailing Address - Fax:618-548-4123
Practice Address - Street 1:113 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1921
Practice Address - Country:US
Practice Address - Phone:618-548-4480
Practice Address - Fax:618-548-4123
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice