Provider Demographics
NPI:1861541203
Name:KAISER, MORGEN M (DDS)
Entity type:Individual
Prefix:DR
First Name:MORGEN
Middle Name:M
Last Name:KAISER
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 1:1375 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-2974
Mailing Address - Country:US
Mailing Address - Phone:847-961-5995
Mailing Address - Fax:
Practice Address - Street 1:502 N HART ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2445
Practice Address - Country:US
Practice Address - Phone:815-943-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist