MEDICARE: KEITH A. MORSE, D.M.D. ,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

General Provider Information

NPI Number	:	1598000572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH A. MORSE, D.M.D. ,PA.

Provider Business Mailing Address
First Line	:	14731 N CLEVELAND AVE STE 1
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3818
Country	:	US
Telephone Number	:	239-995-2257
Fax Number	:	239-995-4388

Provider Business Practice Location Address
First Line	:	14731 N CLEVELAND AVE STE 1
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3818
Country	:	US
Telephone Number	:	239-995-2257
Fax Number	:	239-995-4388

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEITH A MORSE
Credential	:	D.M.D.
Telephone Number	:	239-995-2257

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	12/06/2012

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