MEDICARE: MORGAN STREET DENTAL CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14841	TX

General Provider Information

NPI Number	:	1285832428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORGAN STREET DENTAL CENTER PA

Provider Business Mailing Address
First Line	:	2415 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-884-6106
Fax Number	:	361-884-6106

Provider Business Practice Location Address
First Line	:	2415 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-884-6106
Fax Number	:	361-884-6106

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. PATRICIA A. ROBLES
Credential	:
Telephone Number	:	361-884-6106

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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