Provider Demographics
NPI:1992183420
Name:HABETZ, MORGAN
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:
Last Name:HABETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 C M FAGAN DR
Mailing Address - Street 2:UNIT P
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 C M FAGAN DR
Practice Address - Street 2:UNIT P
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5973
Practice Address - Country:US
Practice Address - Phone:985-622-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist