Provider Demographics
NPI:1124133616
Name:MORRIS, DWIGHT ADAIR (DDS)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:ADAIR
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 RIDGE LAKE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9426
Mailing Address - Country:US
Mailing Address - Phone:901-682-8431
Mailing Address - Fax:901-682-2345
Practice Address - Street 1:780 RIDGE LAKE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9426
Practice Address - Country:US
Practice Address - Phone:901-682-8431
Practice Address - Fax:901-682-2345
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 25961223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2008630OtherBLUE CROSS BLUE SHIELD
TNT74060Medicare UPIN
TN2008630OtherBLUE CROSS BLUE SHIELD