Provider Demographics
NPI:1457321507
Name:MORGAN, JACK CLARENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:CLARENCE
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 1:3003 SOUTH LOOP W
Mailing Address - Street 2:SUITE 555
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1301
Mailing Address - Country:US
Mailing Address - Phone:832-778-9000
Mailing Address - Fax:832-778-9015
Practice Address - Street 1:3003 SOUTH LOOP W
Practice Address - Street 2:SUITE 555
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1301
Practice Address - Country:US
Practice Address - Phone:832-778-9000
Practice Address - Fax:832-778-9015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice