Provider Demographics
NPI:1164770442
Name:MORGAN, AMY SELLERS (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SELLERS
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 PINE BELT DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1348
Mailing Address - Country:US
Mailing Address - Phone:601-283-4800
Mailing Address - Fax:601-283-4802
Practice Address - Street 1:1925 PINE BELT DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1348
Practice Address - Country:US
Practice Address - Phone:601-283-4800
Practice Address - Fax:601-283-4802
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3649-12122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist