Provider Demographics
NPI:1790928190
Name:MORGAN, LORI (DDS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WERKMEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:101 FLAMINGO DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2600
Mailing Address - Country:US
Mailing Address - Phone:813-645-1501
Mailing Address - Fax:
Practice Address - Street 1:101 FLAMINGO DR
Practice Address - Street 2:SUITE D
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2600
Practice Address - Country:US
Practice Address - Phone:813-645-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 198111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice