Provider Demographics
NPI:1568478287
Name:MORGAN, STEPHEN A (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
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 1:219 GRINAGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4525
Mailing Address - Country:US
Mailing Address - Phone:985-868-5699
Mailing Address - Fax:985-223-4221
Practice Address - Street 1:219 GRINAGE ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4525
Practice Address - Country:US
Practice Address - Phone:985-868-5699
Practice Address - Fax:985-223-4221
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1854930Medicaid