Provider Demographics
NPI:1992853345
Name:J. DONALD MOORHEAD, DDS INC.
Entity Type:Organization
Organization Name:J. DONALD MOORHEAD, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-659-9739
Mailing Address - Street 1:2456 W BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3263
Mailing Address - Country:US
Mailing Address - Phone:330-659-9739
Mailing Address - Fax:330-659-2456
Practice Address - Street 1:2456 W BOSTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3263
Practice Address - Country:US
Practice Address - Phone:330-659-9739
Practice Address - Fax:330-659-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty