Provider Demographics
NPI:1568036929
Name:MORGAN, JALON PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JALON
Middle Name:PATRICK
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 NORBOURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4051
Mailing Address - Country:US
Mailing Address - Phone:606-275-9927
Mailing Address - Fax:
Practice Address - Street 1:2902 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3162
Practice Address - Country:US
Practice Address - Phone:502-451-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice