Healthcare Provider Details

I. General information

NPI: 1568948552
Provider Name (Legal Business Name): MORGAN STEELY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E DAY RD STE 150
MISHAWAKA IN
46545-3463
US

IV. Provider business mailing address

230 E DAY RD STE 150
MISHAWAKA IN
46545-3463
US

V. Phone/Fax

Practice location:
  • Phone: 574-800-5080
  • Fax:
Mailing address:
  • Phone: 574-800-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022760
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12014022A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: