MEDICARE: JOHN MORGAN

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	2901601361	MI

General Provider Information

NPI Number	:	1437880887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MORGAN

Provider Business Mailing Address
First Line	:	1462 LAKE DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1746
Country	:	US
Telephone Number	:	810-624-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	3767 28TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-1873
Country	:	US
Telephone Number	:	616-233-2700
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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Directions to “ JOHN MORGAN ” Practice Location

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