Basic Information
| Provider Information | |||||||||
| NPI: | 1366739401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORSE | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 COLLEGE AVE | ||||||||
| Address2: | SUITE D202 | ||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855397401 | ||||||||
| FaxNumber: | 7857768415 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 COLLEGE AVE | ||||||||
| Address2: | SUITE D202 | ||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855397401 | ||||||||
| FaxNumber: | 7857768415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 60832 | KS | Y | Dental Providers | Dentist | General Practice |
No ID Information.