Provider Demographics
NPI:1760807333
Name:MORGAN DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MORGAN DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-644-5255
Mailing Address - Street 1:P.O. BOX 160999
Mailing Address - Street 2:2355 CENTERVILLE ROAD
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-6099
Mailing Address - Country:US
Mailing Address - Phone:850-644-5255
Mailing Address - Fax:
Practice Address - Street 1:960 LEARNING WAY SUITE 3400
Practice Address - Street 2:FLORIDA STATE UNIVERSITY, HEALTH & WELLNESS CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4178
Practice Address - Country:US
Practice Address - Phone:850-644-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL194331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty