Organization
STEPHEN P MORIMOTO, DDS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN P MORIMOTO DDS (PRESIDENT)
(815) 741-0095
Entity
Organization
Contact information
Practice address
219 N HAMMES AVE, JOLIET, IL 60435-8114
(815) 741-0095
(815) 741-0328
Mailing address
219 N HAMMES AVE, JOLIET, IL 60435-8114
(815) 741-0095
(815) 741-0328
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80006668
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/21/2007
Last updated
01/03/2008
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