Elyse M. Morceau, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN012309 Issued in GA

Practice address

205 Hawkins Store Rd NW
Suite 100
Kennesaw, GA 30144-6215

Phone

(770) 926-3400

Fax

(770) 926-6317

NPI assigned

Feb 2, 2006

Last updated

Jan 24, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elyse M. Berkon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elyse M. Morceau, DDS, PC

  dba My Kids' Dentists

  • Pediatric Dentistry
  • Kennesaw, GA
  • NPI 1164687612
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485216000000",
    "number": "1700858032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 FAWNDALE DR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523958",
            "telephone_number": "404-509-4145",
            "fax_number": "770-451-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HAWKINS STORE RD NW",
            "address_2": "SUITE 100",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301446215",
            "telephone_number": "770-926-3400",
            "fax_number": "770-926-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORCEAU",
        "first_name": "ELYSE",
        "middle_name": "M.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2017-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000896629D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELYSE",
            "last_name": "BERKON",
            "middle_name": "M.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine E Moore, LCSW
• Katie Bozeman Moore, PHARMD
• Monica Yvette Moore, M.D
• Stephanie Moore, L.M.P.
• Anna Leckie Moraitakis, PHARMD
• Ernest C Moreland, MD
• Erin E Moreno, OT
• Christine Faith Morgan, PA
• Deirdre Morgan
• Heather Morgan, DC

• Pediatric Dentistry in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.