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General NPI Number Information
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NPI Number | 1164687612
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Entity Type | Organization
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Legal Business Name | ELYSE M. MORCEAU, DDS, PC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/01/2012
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Provider Practice Location Address
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Address Line | 205 HAWKINS STORE RD NW SUITE 100
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City | KENNESAW
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State | GA
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Zip | 30144-6215
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Country | US
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Telephone | 770-926-3400
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Fax | 770-926-6317
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Provider Business Mailing Address
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Address Line | 205 HAWKINS STORE RD NW SUITE 100
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City | KENNESAW
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State | GA
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Zip | 30144-6215
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Country | US
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Telephone | 770-926-3400
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Fax | 770-926-6317
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Authorized Official
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Title or Position | CFO, VP
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Name | MICHAEL MORCEAU
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Credential |
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Telephone | 770-926-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN008821
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN009268
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012309
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License Number State | GA
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