Individual
DR. JACK WALLACE MORRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
18850 DALE MABRY HWY N, LUTZ, FL 33548-4978
(813) 949-6969
(813) 949-3918
Mailing address
10105 WOODSONG WAY, TAMPA, FL 33618-4213
(813) 935-0879
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN004665
FL
Other
Enumeration date
02/10/2009
Last updated
02/10/2009
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