Provider Demographics
NPI:1013199793
Name:MORGAN, KENNETH E (DDS,LLC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DDS,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GENEVIEVE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4811
Mailing Address - Country:US
Mailing Address - Phone:337-981-6882
Mailing Address - Fax:337-991-0542
Practice Address - Street 1:102 GENEVIEVE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4811
Practice Address - Country:US
Practice Address - Phone:337-981-6882
Practice Address - Fax:337-991-0542
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1854921Medicaid