Provider Demographics
NPI:1154167203
Name:BROCKHOUSE, MORGAN ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:BROCKHOUSE
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 1:1731 SYCAMORE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9467
Mailing Address - Country:US
Mailing Address - Phone:309-573-9240
Mailing Address - Fax:
Practice Address - Street 1:1001 ILLINI DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-1883
Practice Address - Country:US
Practice Address - Phone:309-948-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190353311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice