Provider Demographics
NPI:1134570047
Name:MOOREFIELD, JOHANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:MOOREFIELD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 VANDERBILT BEACH RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-1407
Mailing Address - Country:US
Mailing Address - Phone:239-776-7626
Mailing Address - Fax:239-776-7431
Practice Address - Street 1:7485 VANDERBILT BEACH RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-1407
Practice Address - Country:US
Practice Address - Phone:239-776-7626
Practice Address - Fax:239-776-7431
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21955.122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist