Provider Demographics
NPI:1891831095
Name:MORSE HAVIGHURST, JULIE MORSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MORSE
Last Name:MORSE HAVIGHURST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 FAIRMOUNT BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3171
Mailing Address - Country:US
Mailing Address - Phone:216-791-5191
Mailing Address - Fax:216-231-4933
Practice Address - Street 1:2460 FAIRMOUNT BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3171
Practice Address - Country:US
Practice Address - Phone:216-791-5191
Practice Address - Fax:216-231-4933
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-9713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0951368Medicaid