Provider Demographics
NPI:1376626366
Name:MORGAN, MICHAEL SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
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 1:3145 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6950
Mailing Address - Country:US
Mailing Address - Phone:757-340-7602
Mailing Address - Fax:757-340-8609
Practice Address - Street 1:3145 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6950
Practice Address - Country:US
Practice Address - Phone:757-340-7602
Practice Address - Fax:757-340-8609
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA331140OtherBLUE CROSS BLUE SHIELD
VA1982687562OtherORGANIZATIONAL NPI
VA791107OtherUCC