MEDICARE: MORGAN ZOETIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18850	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18850	OTHER	TX	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1104295252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORGAN ZOETIC PLLC

Provider Business Mailing Address
First Line	:	2301 N COLLINS ST STE 230
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N COLLINS ST STE 230
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2647
Country	:	US
Telephone Number	:	281-336-1131
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. PANKAJ JOSHI
Credential	:
Telephone Number	:	281-336-1131

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	09/18/2015

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