Basic Information
| Provider Information | |||||||||
| NPI: | 1043662455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUMOND | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4016 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656259753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178470057 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4016 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656259753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178470057 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2016 | ||||||||
| LastUpdateDate: | 07/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2016021766 | MO | Y | Dental Providers | Dentist | General Practice |
No ID Information.