Provider Demographics
NPI:1073723029
Name:MOREHOUSE, MICHAEL DELBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DELBERT
Last Name:MOREHOUSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 STONEY POINT AVE
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8411
Mailing Address - Country:US
Mailing Address - Phone:717-530-5396
Mailing Address - Fax:717-532-2216
Practice Address - Street 1:9255 OLDE SCOTLAND RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9392
Practice Address - Country:US
Practice Address - Phone:717-532-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031630R122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist