Provider Demographics
NPI:1568986487
Name:RICHARDS, MORGAN CONRAD (DMD)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:CONRAD
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10816 N BLACK SHALE LOOP
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4287
Mailing Address - Country:US
Mailing Address - Phone:850-272-9696
Mailing Address - Fax:
Practice Address - Street 1:3300 N 1200 W SUITE 203
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:850-272-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13342387-9921122300000X
TX33154122300000X
TN11537122300000X
UT13342387-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist