Provider Demographics
NPI:1730292426
Name:MOREHEAD, MICHAEL BRADY (DDS PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRADY
Last Name:MOREHEAD
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 N LOOP 1604 E
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-494-3030
Mailing Address - Fax:210-494-3056
Practice Address - Street 1:400 N LOOP 1604 E
Practice Address - Street 2:STE 320
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-494-3030
Practice Address - Fax:210-494-3056
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice