Healthcare Provider Details

I. General information

NPI: 1679550255
Provider Name (Legal Business Name): WILLIAM J MOORHEAD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S MAIN CROSS ST
FLEMINGSBURG KY
41041-1204
US

IV. Provider business mailing address

PO BOX 474
FLEMINGSBURG KY
41041-0474
US

V. Phone/Fax

Practice location:
  • Phone: 606-845-2273
  • Fax: 606-845-2171
Mailing address:
  • Phone: 606-845-2273
  • Fax: 606-845-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5255
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: