Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 10587 | TN |
Y | 122300000X | Dentist | DF60976684 | WA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DR60847532 | WA |
NPI | 1487175907 |
---|---|
Provider Name | Dr. Kimberly Paige Moorhead |
First Address | Seattle, WA 98195-0001 |
Second Address | Seattle, WA 98195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 26/08/2019 |