Healthcare Provider Details

I. General information

NPI: 1013038447
Provider Name (Legal Business Name): MORGAN AND MORIO ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 BOYSON RD
HIAWATHA IA
52233-2210
US

IV. Provider business mailing address

1395 BOYSON RD
HIAWATHA IA
52233-2210
US

V. Phone/Fax

Practice location:
  • Phone: 319-743-0077
  • Fax: 319-743-0102
Mailing address:
  • Phone: 319-743-0077
  • Fax: 319-743-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number08382
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number08116
License Number StateIA

VIII. Authorized Official

Name: DR. DOMINIC G MORIO
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 319-743-0077