Provider Demographics
NPI:1972732808
Name:MORGAN, SARA MARCELA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:MARCELA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MARCELA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:3967 NIGHTHAWK DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4023
Mailing Address - Country:US
Mailing Address - Phone:312-399-0628
Mailing Address - Fax:
Practice Address - Street 1:7124 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-1601
Practice Address - Country:US
Practice Address - Phone:773-237-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027074122300000X
IL021.0023191223X0400X
FLDN240591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics