Healthcare Provider Details

I. General information

NPI: 1144389511
Provider Name (Legal Business Name): RICHARD J. MORGAN D.D.S.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11250 ROGER BACON DR #13
RESTON VA
20190-5219
US

IV. Provider business mailing address

11250 ROGER BACON DR #13
RESTON VA
20190-5219
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-7775
  • Fax: 703-437-5623
Mailing address:
  • Phone: 703-437-7775
  • Fax: 703-437-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD JACK MORGAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 703-437-7775