Provider Demographics
NPI:1225370281
Name:MENARD, MORGAN EARLE (DMD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:EARLE
Last Name:MENARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LEE
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4825 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2184
Mailing Address - Country:US
Mailing Address - Phone:502-366-6362
Mailing Address - Fax:502-368-8600
Practice Address - Street 1:4825 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2184
Practice Address - Country:US
Practice Address - Phone:502-366-6362
Practice Address - Fax:502-368-8600
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100257000Medicaid