Provider Demographics
NPI:1790797009
Name:MORGAN, KATHERINE MARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ARBORWAY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3663
Mailing Address - Country:US
Mailing Address - Phone:617-524-3900
Mailing Address - Fax:617-524-4838
Practice Address - Street 1:501 ARBORWAY
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3663
Practice Address - Country:US
Practice Address - Phone:617-524-3900
Practice Address - Fax:617-524-4838
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice