Provider Demographics
NPI:1275841900
Name:MORTON DENTAL GROUP
Entity Type:Organization
Organization Name:MORTON DENTAL GROUP
Other - Org Name:MORTON FAMILY DENTISTRY OF FORT SMITH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-474-9696
Mailing Address - Street 1:1122 S WALDRON RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2681
Mailing Address - Country:US
Mailing Address - Phone:479-452-4333
Mailing Address - Fax:479-434-5008
Practice Address - Street 1:1122 S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2681
Practice Address - Country:US
Practice Address - Phone:479-452-4333
Practice Address - Fax:479-434-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty