Healthcare Provider Details

I. General information

NPI: 1780141580
Provider Name (Legal Business Name): MORGAN MARIE NOWERY DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HAMPTON CTR STE B
MORGANTOWN WV
26505-1708
US

IV. Provider business mailing address

3000 HAMPTON CTR STE B
MORGANTOWN WV
26505-1708
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-5000
  • Fax:
Mailing address:
  • Phone: 304-599-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4541
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: