Provider Demographics
NPI:1265516553
Name:MORRIS, DENNIS PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PAUL
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:PAUL
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:13395 SHADOW CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-389-4145
Mailing Address - Fax:
Practice Address - Street 1:6305 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2255
Practice Address - Country:US
Practice Address - Phone:708-425-4300
Practice Address - Fax:708-425-4310
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-150881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP15891OtherMEDICARE PIN
ILT37420Medicare UPIN