Provider Demographics
NPI:1174559983
Name:MORGAN, GREGORY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
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 1:1511 MAIN ST
Mailing Address - Street 2:PO BOX 218
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1419
Mailing Address - Country:US
Mailing Address - Phone:660-259-3381
Mailing Address - Fax:660-259-3660
Practice Address - Street 1:1511 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1419
Practice Address - Country:US
Practice Address - Phone:660-259-3381
Practice Address - Fax:660-259-3660
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0155981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice