Healthcare Provider Details

I. General information

NPI: 1700239647
Provider Name (Legal Business Name): MORGAN PALYA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210
US

IV. Provider business mailing address

342 S HIGHLAND AVE APT 12B
PITTSBURGH PA
15206-5202
US

V. Phone/Fax

Practice location:
  • Phone: 614-688-3763
  • Fax:
Mailing address:
  • Phone: 724-317-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025430
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: