Healthcare Provider Details

I. General information

NPI: 1740653146
Provider Name (Legal Business Name): ISSAC DRAKE MORTON DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ISAAC DRAKE MORTON DMD, MD

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 08/14/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD MEDICAL PLAZA 1, SUITE 306
BATON ROUGE LA
70808
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE 306
BATON ROUGE LA
70808-4365
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-3939
  • Fax: 225-763-3947
Mailing address:
  • Phone: 225-763-3939
  • Fax: 225-763-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number36130
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number11335
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number345913
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number7712
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: