Provider Demographics
NPI:1013402981
Name:MORGAN-MICHAELS FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:MORGAN-MICHAELS FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-663-4114
Mailing Address - Street 1:2100 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4321
Mailing Address - Country:US
Mailing Address - Phone:309-663-4114
Mailing Address - Fax:309-663-1275
Practice Address - Street 1:2100 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4321
Practice Address - Country:US
Practice Address - Phone:309-663-4114
Practice Address - Fax:309-663-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-24
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental