Healthcare Provider Details

I. General information

NPI: 1093818643
Provider Name (Legal Business Name): CHARLES CALVIN MORGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 POINT BROWN AVE NE
OCEAN SHORES WA
98569
US

IV. Provider business mailing address

PO BOX 1538
OCEAN SHORES WA
98569
US

V. Phone/Fax

Practice location:
  • Phone: 360-289-5284
  • Fax: 360-289-2945
Mailing address:
  • Phone: 360-289-5284
  • Fax: 360-289-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7796
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: