Provider Demographics
NPI:1982240024
Name:MORGAN, AUTUMN (DDS)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
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 1:2720 STANGE RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3974
Mailing Address - Country:US
Mailing Address - Phone:515-268-0516
Mailing Address - Fax:
Practice Address - Street 1:2720 STANGE RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3974
Practice Address - Country:US
Practice Address - Phone:515-268-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75901223G0001X
IADDS-100361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice