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General NPI Number Information
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NPI Number | 1245410968
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Entity Type | Organization
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Legal Business Name | MORGAN DENTAL CORPORATION
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 1502 E COLLINS AVE
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City | ORANGE
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State | CA
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Zip | 92867
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Country | US
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Telephone | 714-288-8464
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Fax | 714-288-8474
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Provider Business Mailing Address
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Address Line | 4497 S GLENMERE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-9217
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Country | US
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Telephone | 208-576-3840
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Fax | 208-576-3839
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Authorized Official
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Title or Position | CEO
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Name | JASON H MORGAN
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Credential | DDS
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Telephone | 208-576-3840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50648
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License Number State | CA
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