Provider Demographics
NPI:1972056240
Name:MORGAN DENTISTRY, PA
Entity type:Organization
Organization Name:MORGAN DENTISTRY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-629-4100
Mailing Address - Street 1:1008 MISSION PARK DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3735
Mailing Address - Country:US
Mailing Address - Phone:601-629-4100
Mailing Address - Fax:601-629-4101
Practice Address - Street 1:1008 MISSION PARK DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3735
Practice Address - Country:US
Practice Address - Phone:601-629-4100
Practice Address - Fax:601-629-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3872-16122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty