Individual
BRADLEY JAY MORLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3323 4TH ST, LEWISTON, ID 83501-4423
(208) 743-1114
(208) 743-0120
Mailing address
3323 4TH ST, LEWISTON, ID 83501-4423
(208) 743-1114
(208) 743-0120
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D2072PE
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D2072 PE
DENTAL LICENSE
ID
Enumeration date
09/20/2006
Last updated
07/08/2007
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