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General NPI Number Information
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NPI Number | 1992853345
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Entity Type | Organization
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Legal Business Name | J. DONALD MOORHEAD, DDS INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 2456 W BOSTON RD
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-3263
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Country | US
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Telephone | 330-659-9739
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Fax | 330-659-2456
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Provider Business Mailing Address
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Address Line | 2456 W BOSTON RD
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-3263
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Country | US
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Telephone | 330-659-9739
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Fax | 330-659-2456
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN DONALD MOORHEAD
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Credential | DDS
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Telephone | 330-659-9739
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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 | 12276
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License Number State | OH
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