Provider Demographics
NPI:1194827287
Name:MORIN, CHARLES K (DMD,MSC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:MORIN
Suffix:
Gender:M
Credentials:DMD,MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CENTRAL AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8626
Mailing Address - Country:US
Mailing Address - Phone:406-656-6100
Mailing Address - Fax:406-281-8025
Practice Address - Street 1:2900 CENTRAL AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8626
Practice Address - Country:US
Practice Address - Phone:406-656-6100
Practice Address - Fax:406-281-8025
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100069770A122300000X
CO54431223P0221X
MT115011223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02544302Medicaid
OK100069770AMedicaid