Provider Demographics
NPI:1245410968
Name:MORGAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:MORGAN DENTAL CORPORATION
Other - Org Name:CALIFORNIA DENTAL GROUP OF ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-576-3840
Mailing Address - Street 1:4497 S GLENMERE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9217
Mailing Address - Country:US
Mailing Address - Phone:208-576-3840
Mailing Address - Fax:208-576-3839
Practice Address - Street 1:1502 E COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:714-288-8464
Practice Address - Fax:714-288-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty