Provider Demographics
NPI:1487749669
Name:MORGAN, RICHARD JACK SR (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JACK
Last Name:MORGAN
Suffix:SR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:11250 ROGER BACON DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5219
Mailing Address - Country:US
Mailing Address - Phone:703-437-7775
Mailing Address - Fax:703-437-5623
Practice Address - Street 1:11250 ROGER BACON DR
Practice Address - Street 2:SUITE 13
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5219
Practice Address - Country:US
Practice Address - Phone:703-437-7775
Practice Address - Fax:703-437-5623
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
VA0401004793122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics