Provider Demographics
NPI:1902991862
Name:MOORHEAD, BARRY JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JOHN
Last Name:MOORHEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16375 NE 85TH ST
Mailing Address - Street 2:#103
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3554
Mailing Address - Country:US
Mailing Address - Phone:425-885-4741
Mailing Address - Fax:425-883-7101
Practice Address - Street 1:16375 NE 85TH ST
Practice Address - Street 2:#103
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3554
Practice Address - Country:US
Practice Address - Phone:425-885-4741
Practice Address - Fax:425-883-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice