Provider Demographics
NPI:1740736230
Name:MORGAN, MEREDITH EILEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:EILEEN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:EILEEN
Other - Last Name:BRUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:878 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2725
Mailing Address - Country:US
Mailing Address - Phone:805-541-0550
Mailing Address - Fax:
Practice Address - Street 1:878 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2725
Practice Address - Country:US
Practice Address - Phone:805-541-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice