Basic Information
| Provider Information | |||||||||
| NPI: | 1508207408 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL M. MORGAN, D.M.D, PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2140 LAKE EUSTIS DR | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327782064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527423500 | ||||||||
| FaxNumber: | 3527420668 | ||||||||
| Practice Location | |||||||||
| Address1: | 2140 LAKE EUSTIS DR | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327782064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527423500 | ||||||||
| FaxNumber: | 3527420668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | MORGAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | MAYNES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3527423500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN11130 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 073182000 | 05 | FL | MEDICAID |