Provider Demographics
NPI:1104020072
Name:MIKE MORTON DDS, PLLC
Entity Type:Organization
Organization Name:MIKE MORTON DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-938-3189
Mailing Address - Street 1:201 SECURITY ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-2757
Mailing Address - Country:US
Mailing Address - Phone:704-938-3189
Mailing Address - Fax:704-938-3190
Practice Address - Street 1:201 SECURITY ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-2757
Practice Address - Country:US
Practice Address - Phone:704-938-3189
Practice Address - Fax:704-938-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty