Provider Demographics
NPI:1861544470
Name:MORRIS, BRIAN K (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1384
Mailing Address - Country:US
Mailing Address - Phone:740-286-0480
Mailing Address - Fax:740-286-8968
Practice Address - Street 1:190 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1384
Practice Address - Country:US
Practice Address - Phone:740-286-0480
Practice Address - Fax:740-286-8968
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330007Medicaid
OH2569135Medicaid