Provider Demographics
NPI:1114912490
Name:MORGAN, MONTE D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:D
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RAMSGATE SQ S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5876
Mailing Address - Country:US
Mailing Address - Phone:503-362-7869
Mailing Address - Fax:503-362-5034
Practice Address - Street 1:160 RAMSGATE SQ S
Practice Address - Street 2:SUITE 150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5876
Practice Address - Country:US
Practice Address - Phone:503-362-7869
Practice Address - Fax:503-362-5034
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist