MEDICARE: MISS MORGAN R FARRELL RDH

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	124Q00000X	Dental Hygienist	DH02525	FL

General Provider Information

NPI Number	:	1104418102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MORGAN R FARRELL RDH

Provider Business Mailing Address
First Line	:	1081 A1A BEACH BLVD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-6733
Country	:	US
Telephone Number	:	904-471-3291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 A1A BEACH BLVD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-6733
Country	:	US
Telephone Number	:	904-471-3291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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