Provider Demographics
NPI:1699208264
Name:SMITH, MORGAN BOAEN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BOAEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 PAULSEN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4424
Mailing Address - Country:US
Mailing Address - Phone:912-298-5437
Mailing Address - Fax:912-298-5438
Practice Address - Street 1:4849 PAULSEN ST STE 101
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4424
Practice Address - Country:US
Practice Address - Phone:912-298-5437
Practice Address - Fax:912-298-5438
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry