Provider Demographics
NPI:1164552519
Name:MORGAN, W K SR (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:K
Last Name:MORGAN
Suffix:SR
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 HENDERSON DR EXT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-347-1283
Mailing Address - Fax:910-347-2153
Practice Address - Street 1:3445 HENDERSON DR EXT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-347-1283
Practice Address - Fax:910-347-2153
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015K3OtherBCBS
NC96180OtherBCBS
NC8996180Medicaid