MEDICARE: MORGAN CECILIA PETSCHE

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	122300000X	Dentist	DDS-10250	IA

General Provider Information

NPI Number	:	1366288938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN CECILIA PETSCHE

Provider Business Mailing Address
First Line	:	945 JUNEBERRY DR
Second Line	:
City	:	PALO
State	:	IA
Zip	:	52324-9686
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 42ND ST NE STE 1
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5700
Country	:	US
Telephone Number	:	319-393-6152
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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Directions to “ MORGAN CECILIA PETSCHE ” Practice Location

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