Provider Demographics
NPI:1760134746
Name:BRAZILE AND MOOREHEAD PLLC
Entity Type:Organization
Organization Name:BRAZILE AND MOOREHEAD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-968-6558
Mailing Address - Street 1:763 PROSPECT LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8700 PINEVILLE MATTHEWS RD STE 920
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4748
Practice Address - Country:US
Practice Address - Phone:704-968-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty