Provider Demographics
NPI:1962737916
Name:W BRITT MORRIS, DMD PC
Entity type:Organization
Organization Name:W BRITT MORRIS, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-459-3425
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-0396
Mailing Address - Country:US
Mailing Address - Phone:205-459-3425
Mailing Address - Fax:205-459-3436
Practice Address - Street 1:123 W ALABAMA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2211
Practice Address - Country:US
Practice Address - Phone:205-459-3425
Practice Address - Fax:205-459-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51091117OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL009962600Medicaid