Provider Demographics
NPI:1104984418
Name:MORGAN, MARK RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W 4TH ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5145
Mailing Address - Country:US
Mailing Address - Phone:775-827-3746
Mailing Address - Fax:775-324-1968
Practice Address - Street 1:1155 W 4TH ST
Practice Address - Street 2:SUITE 218
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5145
Practice Address - Country:US
Practice Address - Phone:775-827-3746
Practice Address - Fax:775-324-1968
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics