Provider Demographics
NPI:1750545208
Name:MOORHEAD, LORENA
Entity type:Individual
Prefix:DR
First Name:LORENA
Middle Name:
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LORETO
Other - Middle Name:
Other - Last Name:ZARATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1050 E UNIVERSITY DR STE 11
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8046
Mailing Address - Country:US
Mailing Address - Phone:480-610-2401
Mailing Address - Fax:480-890-0812
Practice Address - Street 1:1050 E UNIVERSITY DR STE 11
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8046
Practice Address - Country:US
Practice Address - Phone:480-610-2401
Practice Address - Fax:480-890-0812
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist