Provider Demographics
NPI:1508207408
Name:MICHAEL M. MORGAN, D.M.D, PA
Entity Type:Organization
Organization Name:MICHAEL M. MORGAN, D.M.D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MAYNES
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-742-3500
Mailing Address - Street 1:2140 LAKE EUSTIS DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2064
Mailing Address - Country:US
Mailing Address - Phone:352-742-3500
Mailing Address - Fax:352-742-0668
Practice Address - Street 1:2140 LAKE EUSTIS DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2064
Practice Address - Country:US
Practice Address - Phone:352-742-3500
Practice Address - Fax:352-742-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN111301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073182000Medicaid