Provider Demographics
NPI:1598085300
Name:MORGAN, JAMIE WINTERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:WINTERS
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CONRAD HARCOURT WAY
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1100
Mailing Address - Country:US
Mailing Address - Phone:765-932-5533
Mailing Address - Fax:
Practice Address - Street 1:200 CONRAD HARCOURT WAY
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1100
Practice Address - Country:US
Practice Address - Phone:765-932-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011447A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist