Provider Demographics
NPI:1720617160
Name:BISHOP, MORGAN KESECKER
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:KESECKER
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9009
Mailing Address - Country:US
Mailing Address - Phone:304-619-6054
Mailing Address - Fax:
Practice Address - Street 1:1880 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-8858
Practice Address - Country:US
Practice Address - Phone:540-433-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist