Provider Demographics
NPI:1730176439
Name:MORGENROTH, JAMES C (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:MORGENROTH
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 1:13500 W CAPITOL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2444
Mailing Address - Country:US
Mailing Address - Phone:262-790-9322
Mailing Address - Fax:262-790-9323
Practice Address - Street 1:13500 W CAPITOL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2444
Practice Address - Country:US
Practice Address - Phone:262-790-9322
Practice Address - Fax:262-790-9323
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001046-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33538100Medicaid
391383362OtherFEDERAL EIN