Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS041939 | PA |
NPI | 1003398850 |
---|---|
Provider Name | Bailey Moorhead |
First Address | Fort Bragg, NC 28310-7302 |
Second Address | Fort Bragg, NC 28307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2018 |
Last Update Date | 29/08/2018 |