=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225916505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYAN J MORGAN NORTH RIVER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5045 MOCCASIN WALLOW ROAD
-----------------------------------------------------
City | PALMETTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-360-7731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14011 11TH TER NE
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34212-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-360-7731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRYAN JOSEPH MORGAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 772-360-7731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------