Provider Demographics
NPI:1356462592
Name:MORGAN, MARK DOYLE (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOYLE
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 W HIGHWAY 287 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4706
Mailing Address - Country:US
Mailing Address - Phone:972-937-6654
Mailing Address - Fax:
Practice Address - Street 1:1618 W HIGHWAY 287 BUSINESS
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-4706
Practice Address - Country:US
Practice Address - Phone:972-937-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice