Provider Demographics
NPI:1417006909
Name:MORGAN, ELLEN PROCTOR (DDS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PROCTOR
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOLLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9746
Mailing Address - Country:US
Mailing Address - Phone:859-497-2141
Mailing Address - Fax:859-497-2142
Practice Address - Street 1:105 BRUCE PROFESSIONAL PLZ
Practice Address - Street 2:SUITE C
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-8504
Practice Address - Country:US
Practice Address - Phone:859-497-2141
Practice Address - Fax:859-497-2142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice