Provider Demographics
NPI:1043331200
Name:MORGAN, JOSEPH THADDEUS (DMD, PA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THADDEUS
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6015
Mailing Address - Country:US
Mailing Address - Phone:407-324-7879
Mailing Address - Fax:407-324-2427
Practice Address - Street 1:145 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6015
Practice Address - Country:US
Practice Address - Phone:407-324-7879
Practice Address - Fax:407-324-2427
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00138691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice