Provider Demographics
NPI:1720179815
Name:MORGAN, EDWARD RALPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RALPH
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627-1661
Mailing Address - Country:US
Mailing Address - Phone:724-694-5420
Mailing Address - Fax:
Practice Address - Street 1:400 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:PA
Practice Address - Zip Code:15627-1661
Practice Address - Country:US
Practice Address - Phone:724-694-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019553-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice