Healthcare Provider Details

I. General information

NPI: 1821584061
Provider Name (Legal Business Name): MORGAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 E IMPERIAL HWY
BREA CA
92821-6714
US

IV. Provider business mailing address

1803 ELLIS AVE
CALDWELL ID
83605-4810
US

V. Phone/Fax

Practice location:
  • Phone: 714-572-2818
  • Fax:
Mailing address:
  • Phone: 208-229-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDDS50648
License Number StateCA

VIII. Authorized Official

Name: JASON H MORGAN
Title or Position: OWNER CEO
Credential:
Phone: 208-229-0403