Provider Demographics
NPI:1447496856
Name:MORGAN, CHALISE MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHALISE
Middle Name:MICHELLE
Last Name:MORGAN
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 1:3671 ARCHETTO DR.
Mailing Address - Street 2:
Mailing Address - City:EDH
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7503
Mailing Address - Country:US
Mailing Address - Phone:619-549-5645
Mailing Address - Fax:
Practice Address - Street 1:5168 HONPIE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8682
Practice Address - Country:US
Practice Address - Phone:530-387-4232
Practice Address - Fax:530-387-8079
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice