Provider Demographics
NPI:1477627479
Name:MORGAN, MARK T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
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:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-0709
Mailing Address - Country:US
Mailing Address - Phone:507-825-5403
Mailing Address - Fax:507-825-6413
Practice Address - Street 1:101 2ND ST SE
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1900
Practice Address - Country:US
Practice Address - Phone:507-825-5403
Practice Address - Fax:507-825-6413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice