Provider Demographics
NPI:1912782160
Name:MOOREHEAD DENTISTRY LLC
Entity Type:Organization
Organization Name:MOOREHEAD DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-462-6583
Mailing Address - Street 1:285 E MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3041
Mailing Address - Country:US
Mailing Address - Phone:513-732-0541
Mailing Address - Fax:513-732-0552
Practice Address - Street 1:285 E MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-3041
Practice Address - Country:US
Practice Address - Phone:513-732-0541
Practice Address - Fax:513-732-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty