Provider Demographics
NPI:1457435497
Name:MORGAN, LANNY TAD (DDS)
Entity Type:Individual
Prefix:
First Name:LANNY
Middle Name:TAD
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17789 FM 344 W
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-6007
Mailing Address - Country:US
Mailing Address - Phone:903-825-1112
Mailing Address - Fax:903-825-1115
Practice Address - Street 1:17789 FM 344 W
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-6007
Practice Address - Country:US
Practice Address - Phone:903-825-1112
Practice Address - Fax:903-825-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice