Provider Demographics
NPI:1508099789
Name:MCEVOY, MORGAN KENNEDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:KENNEDY
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MORGAN
Other - Middle Name:LYNN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:114 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1200
Mailing Address - Country:US
Mailing Address - Phone:251-709-7040
Mailing Address - Fax:
Practice Address - Street 1:22645 HWY 59 SOUTH
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-0000
Practice Address - Country:US
Practice Address - Phone:251-621-1370
Practice Address - Fax:251-621-1374
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5688122300000X
NC92611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice