Provider Demographics
NPI:1124578075
Name:MORGAN FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:MORGAN FAMILY DENTISTRY, PLLC
Other - Org Name:MONTICELLO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGEMENT CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:501-483-3939
Mailing Address - Street 1:715 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3310
Mailing Address - Country:US
Mailing Address - Phone:501-483-3939
Mailing Address - Fax:
Practice Address - Street 1:501 HWY 425 SOUTH
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655
Practice Address - Country:US
Practice Address - Phone:870-367-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORGAN FAMILY DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR37501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty