Provider Demographics
NPI:1053987396
Name:MOROZUMI, MARK F (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:MOROZUMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W EXPY 83 STE 800
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4348
Mailing Address - Country:US
Mailing Address - Phone:956-277-2414
Mailing Address - Fax:
Practice Address - Street 1:1901 W EXPY 83 STE 800
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4348
Practice Address - Country:US
Practice Address - Phone:956-277-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist