Provider Demographics
NPI:1629295746
Name:MOORHEAD, GERNIE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERNIE
Middle Name:M
Last Name:MOORHEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:561-655-3213
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:561-655-3213
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice