Provider Demographics
NPI:1205878071
Name:WILLIAM J MORSE FAMILY DENTISTRY INC.
Entity type:Organization
Organization Name:WILLIAM J MORSE FAMILY DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-471-3300
Mailing Address - Street 1:2199 A1A S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6513
Mailing Address - Country:US
Mailing Address - Phone:904-471-3300
Mailing Address - Fax:904-471-5240
Practice Address - Street 1:2199 A1A S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6513
Practice Address - Country:US
Practice Address - Phone:904-471-3300
Practice Address - Fax:904-471-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2755OtherLICENSE NO
FL11855OtherLICENSE NO
FL18077OtherLICENSES NO
FL8828OtherLICENCES NO