Provider Demographics
NPI:1477671857
Name:MORGAN, MARK SIDNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SIDNEY
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 1:312 HILLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7035
Mailing Address - Country:US
Mailing Address - Phone:919-787-3116
Mailing Address - Fax:
Practice Address - Street 1:1034 BRAGG ST
Practice Address - Street 2:MSC 4287
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-4287
Practice Address - Country:US
Practice Address - Phone:919-733-4340
Practice Address - Fax:919-733-1593
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice