Organization
ELYSE M. MORCEAU, DDS, PC
Active
Other names
My Kids' Dentists
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MORCEAU (CFO, VP)
(770) 926-3400
Entity
Organization
Contact information
Practice address
205 HAWKINS STORE RD NW, SUITE 100, KENNESAW, GA 30144-6215
(770) 926-3400
(770) 926-6317
Mailing address
205 HAWKINS STORE RD NW, SUITE 100, KENNESAW, GA 30144-6215
(770) 926-3400
(770) 926-6317
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
DN008821
GA
1223P0221X
Pediatric Dentistry
DN009268
GA
1223P0221X
Pediatric Dentistry
Primary
DN012309
GA
1223P0221X
Pediatric Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000157924B
—
GA
05
—
00349423C
—
GA
05
—
00896629D
—
GA
Enumeration date
07/24/2008
Last updated
07/01/2012
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