Provider Demographics
NPI:1952306813
Name:MOREHEAD, JONATHAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:MOREHEAD
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 1:1557 BRICE ST.
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201
Mailing Address - Country:US
Mailing Address - Phone:303-717-5893
Mailing Address - Fax:
Practice Address - Street 1:1557 BRICE ST.
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201
Practice Address - Country:US
Practice Address - Phone:303-717-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15951223G0001X
CO80211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice