Provider Demographics
NPI:1104369750
Name:WILLIAM J MOORHEAD DMD PLLC
Entity Type:Organization
Organization Name:WILLIAM J MOORHEAD DMD PLLC
Other - Org Name:FLEMINGSBURG DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-845-2273
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-0474
Mailing Address - Country:US
Mailing Address - Phone:606-845-2273
Mailing Address - Fax:888-724-9594
Practice Address - Street 1:303 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1204
Practice Address - Country:US
Practice Address - Phone:606-845-2273
Practice Address - Fax:888-724-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5255261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental