Organization
DRS MOORHEAD& ROSS DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER L MOORHEAD DDS (PARTNER)
(907) 874-3731
Entity
Organization
Contact information
Practice address
215 FRONT ST, WRANGELL, AK 99929
(907) 874-3731
(907) 874-3531
Mailing address
PO BOX 1140, WRANGELL, AK 99929
(907) 874-3731
(907) 874-3531
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
550
AK
1223G0001X
General Practice Dentistry
570
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD0550 DD0570
—
AL
Enumeration date
12/14/2006
Last updated
04/20/2008
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