Provider Demographics
NPI:1437594231
Name:MOORHEAD AND FERLITA
Entity Type:Organization
Organization Name:MOORHEAD AND FERLITA
Other - Org Name:NORTH FLAGLER DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-655-1104
Mailing Address - Street 1:1911 N FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6111
Mailing Address - Country:US
Mailing Address - Phone:561-655-1104
Mailing Address - Fax:
Practice Address - Street 1:1911 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6111
Practice Address - Country:US
Practice Address - Phone:561-655-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty