Provider Demographics
NPI:1598000572
Name:KEITH A. MORSE, D.M.D. ,PA.
Entity Type:Organization
Organization Name:KEITH A. MORSE, D.M.D. ,PA.
Other - Org Name:COMMUNITY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-995-2257
Mailing Address - Street 1:14731 N CLEVELAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-3818
Mailing Address - Country:US
Mailing Address - Phone:239-995-2257
Mailing Address - Fax:239-995-4388
Practice Address - Street 1:14731 N CLEVELAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3818
Practice Address - Country:US
Practice Address - Phone:239-995-2257
Practice Address - Fax:239-995-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty