Provider Demographics
NPI:1023166675
Name:MORGAN, MICHAEL MAYNES (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MAYNES
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38036 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9399
Mailing Address - Country:US
Mailing Address - Phone:352-669-8655
Mailing Address - Fax:
Practice Address - Street 1:2140 LAKE EUSTIS DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2064
Practice Address - Country:US
Practice Address - Phone:352-742-3500
Practice Address - Fax:352-742-0668
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD11130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist