Provider Demographics
NPI:1700843406
Name:MORGAN, W. KENNETH JR
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:KENNETH
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 BENJAMIN PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2015
Mailing Address - Country:US
Mailing Address - Phone:336-288-0010
Mailing Address - Fax:336-282-5754
Practice Address - Street 1:1602 BENJAMIN PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2015
Practice Address - Country:US
Practice Address - Phone:336-288-0010
Practice Address - Fax:336-282-5754
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996186Medicaid