Provider Demographics
NPI:1659388346
Name:MORGAN, LAURA SUPAK (DDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUPAK
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:104 PROFESSIONAL PLACE
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-938-1688
Mailing Address - Fax:972-937-3420
Practice Address - Street 1:104 PROFESSIONAL PLACE
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-938-1688
Practice Address - Fax:972-937-3420
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist