Provider Demographics
NPI:1376548586
Name:MORTON, STEVEN DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:MORTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9572
Mailing Address - Country:US
Mailing Address - Phone:518-477-8706
Mailing Address - Fax:
Practice Address - Street 1:1654 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9572
Practice Address - Country:US
Practice Address - Phone:518-477-8706
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:2006-04-04
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
NY0341941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00545868Medicaid