Healthcare Provider Details

I. General information

NPI: 1144280876
Provider Name (Legal Business Name): WILLIAM RUSSELL MORGAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E MATTHEWS AVE SUITE 101
JONESBORO AR
72401-4315
US

IV. Provider business mailing address

1107 E MATTHEWS AVE SUITE 101
JONESBORO AR
72401-4315
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-8657
  • Fax: 870-932-8671
Mailing address:
  • Phone: 870-932-8657
  • Fax: 870-932-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2216
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: