Healthcare Provider Details

I. General information

NPI: 1538424619
Provider Name (Legal Business Name): DAVID M MORGAN, DDS, MD, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S WEST ST STE 103
ALEXANDRIA VA
22314-2800
US

IV. Provider business mailing address

124 S WEST ST STE 103
ALEXANDRIA VA
22314-2800
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-7841
  • Fax: 703-751-7858
Mailing address:
  • Phone: 703-751-7841
  • Fax: 703-751-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401412738
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID M MORGAN
Title or Position: ORAL SURGEON, OWNER
Credential: DDS, MD
Phone: 703-751-7841