MEDICARE: DR. JACK CLARENCE MORGAN D.D.S.

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	13369	TX

General Provider Information

NPI Number	:	1457321507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK CLARENCE MORGAN D.D.S.

Provider Business Mailing Address
First Line	:	3003 SOUTH LOOP W
Second Line	:	SUITE 555
City	:	HOUSTON
State	:	TX
Zip	:	77054-1301
Country	:	US
Telephone Number	:	832-778-9000
Fax Number	:	832-778-9015

Provider Business Practice Location Address
First Line	:	3003 SOUTH LOOP W
Second Line	:	SUITE 555
City	:	HOUSTON
State	:	TX
Zip	:	77054-1301
Country	:	US
Telephone Number	:	832-778-9000
Fax Number	:	832-778-9015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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