Healthcare Provider Details

I. General information

NPI: 1497180889
Provider Name (Legal Business Name): BRIAN SAMUEL MORNINGSTAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 DOVER CENTER RD
BAY VILLAGE OH
44140-2376
US

IV. Provider business mailing address

660 DOVER CENTER RD
BAY VILLAGE OH
44140-2376
US

V. Phone/Fax

Practice location:
  • Phone: 330-899-7950
  • Fax: 440-899-0124
Mailing address:
  • Phone: 440-899-7950
  • Fax: 440-899-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: