Provider Demographics
NPI:1588750848
Name:MORNINGSTAR, WILLIAM GEORGE (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEORGE
Last Name:MORNINGSTAR
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:EXIT 102 I-40 SOUTH 1/2 MI
Mailing Address - Street 2:ACL INDIAN HOSP IHS ATTN BUS OFFICE
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-5385
Mailing Address - Fax:505-552-5473
Practice Address - Street 1:I-40 EXIT 102 SOUTH 1/2 MI
Practice Address - Street 2:ACL INDIAN HOSPITAL
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-552-5310
Practice Address - Fax:505-552-5490
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
PHS000Medicare UPIN
NMH3451Medicaid