Provider Demographics
NPI:1316097587
Name:MORRISON, RICHARD B (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:MORRISON
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:PICKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49774-0308
Mailing Address - Country:US
Mailing Address - Phone:906-647-9395
Mailing Address - Fax:
Practice Address - Street 1:205 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:PICKFORD
Practice Address - State:MI
Practice Address - Zip Code:49774-0308
Practice Address - Country:US
Practice Address - Phone:906-647-9201
Practice Address - Fax:906-647-2550
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI126591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316097587Medicaid
MIMO100046OtherUNITED CONCORDIA
MI1972578Medicaid