Provider Demographics
NPI:1528733854
Name:MORRIS, DESIRE MARIE (PHDHP)
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2131
Mailing Address - Country:US
Mailing Address - Phone:570-691-8664
Mailing Address - Fax:
Practice Address - Street 1:9 STEARNS LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8850
Practice Address - Country:US
Practice Address - Phone:570-284-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000662124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist