Provider Demographics
NPI:1528697000
Name:MORGALO, PAULINE S (RDH)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:S
Last Name:MORGALO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LOCUST ST
Mailing Address - Street 2:NONE
Mailing Address - City:TUSCARORA
Mailing Address - State:PA
Mailing Address - Zip Code:17982
Mailing Address - Country:US
Mailing Address - Phone:229-630-7736
Mailing Address - Fax:
Practice Address - Street 1:1032 PARK RD
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9558
Practice Address - Country:US
Practice Address - Phone:610-926-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH012821124Q00000X
PADH073772124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist