Provider Demographics
NPI:1720230329
Name:MORRA, MICHAEL JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JASON
Last Name:MORRA
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 1:6415 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8366
Mailing Address - Country:US
Mailing Address - Phone:407-382-2282
Mailing Address - Fax:
Practice Address - Street 1:6415 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8366
Practice Address - Country:US
Practice Address - Phone:407-382-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist