Provider Demographics
NPI:1962419655
Name:MORTON, THOMAS LEE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:MORTON
Suffix:JR
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 1:24 DEAVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1706
Mailing Address - Country:US
Mailing Address - Phone:828-254-6024
Mailing Address - Fax:
Practice Address - Street 1:24 DEAVERVIEW RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1706
Practice Address - Country:US
Practice Address - Phone:828-254-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996232Medicaid