Provider Demographics
NPI:1811209786
Name:MORGAN, SEAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:R
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W TEMPLE AVE
Mailing Address - Street 2:208
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2121
Mailing Address - Country:US
Mailing Address - Phone:217-342-0211
Mailing Address - Fax:217-342-0232
Practice Address - Street 1:900 W TEMPLE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2121
Practice Address - Country:US
Practice Address - Phone:217-342-0211
Practice Address - Fax:217-342-0232
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190283721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice