Provider Demographics
NPI:1104372796
Name:MOORHEAD, ANNA GILREATH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:GILREATH
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 GULICK AVENUE, ATTN CREDENTIALS COORDINATOR
Mailing Address - Street 2:US ARMY DENTAL HEALTH ACTIVITY
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-7045
Mailing Address - Fax:
Practice Address - Street 1:9900 LINCOLN STREET, 2ND FLOOR
Practice Address - Street 2:US ARMY DENTAC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-698-4079
Practice Address - Fax:253-968-5919
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8786122300000X
SCDGD.104201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist