Provider Demographics
NPI:1063722775
Name:COBRAN, MORGAN RENALD (DDS)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:RENALD
Last Name:COBRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 SW MAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5769
Mailing Address - Country:US
Mailing Address - Phone:386-752-7373
Mailing Address - Fax:
Practice Address - Street 1:1166 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:863-752-7373
Practice Address - Fax:386-487-1265
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice