Provider Demographics
NPI:1184878126
Name:MORKIN, DAVID MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:MORKIN
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 1:2103 E. WASHINGTON STREET
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701
Mailing Address - Country:US
Mailing Address - Phone:309-661-1212
Mailing Address - Fax:309-661-1149
Practice Address - Street 1:2103 E. WASHINGTON STREET
Practice Address - Street 2:SUITE 2E
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-661-1212
Practice Address - Fax:309-661-1149
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist