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General NPI Number Information
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NPI Number | 1487175907
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Entity Type | Individual
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Provider Name | KIMBERLY PAIGE MOORHEAD DDS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 05/25/2024
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Provider Practice Location Address
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Address Line | 1530 S UNION AVE STE 7
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City | TACOMA
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State | WA
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Zip | 98405-1954
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Country | US
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Telephone | 253-201-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 S UNION AVE STE 7
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City | TACOMA
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State | WA
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Zip | 98405-1954
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Country | US
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Telephone | 253-201-5859
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10587
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DF60976684
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DR60847532
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60960113
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License Number State | WA
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