Provider Demographics
NPI:1396804647
Name:MORGAN, EDYTHE MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:EDYTHE
Middle Name:MICHELLE
Last Name:MORGAN
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 1:8122 SAN CRISTOBAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4430
Mailing Address - Country:US
Mailing Address - Phone:214-321-8954
Mailing Address - Fax:
Practice Address - Street 1:303 E. PLEASANT RUN ROAD
Practice Address - Street 2:
Practice Address - City:DE-SOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-0000
Practice Address - Country:US
Practice Address - Phone:972-224-2020
Practice Address - Fax:972-224-2282
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17214122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice