Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 60372817 | WA |
NPI | 1053608331 |
---|---|
Provider Name | Kirk Thomas Morris |
First Address | Kennewick, WA 99338-1899 |
Second Address | Kennewick, WA 99338-1899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 17/03/2018 |