Provider Demographics
NPI:1124710660
Name:MORTON, PHILIP (DDS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MORTON
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 1:1828 W LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-1725
Mailing Address - Country:US
Mailing Address - Phone:580-889-7900
Mailing Address - Fax:
Practice Address - Street 1:1828 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-1725
Practice Address - Country:US
Practice Address - Phone:580-889-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist