Provider Demographics
NPI:1144280876
Name:MORGAN, WILLIAM RUSSELL (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
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 1:1107 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4315
Mailing Address - Country:US
Mailing Address - Phone:870-932-8657
Mailing Address - Fax:870-932-8671
Practice Address - Street 1:1107 E MATTHEWS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4315
Practice Address - Country:US
Practice Address - Phone:870-932-8657
Practice Address - Fax:870-932-8671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58312Medicare ID - Type Unspecified
T20417Medicare UPIN