Individual
JACOB MOORHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1130 S COUNTRY CLUB DR STE 101, MESA, AZ 85210-4639
(480) 461-9866
Mailing address
1130 S COUNTRY CLUB DR STE 101, MESA, AZ 85210-4639
(480) 461-9866
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D011356
AZ
Other
Enumeration date
05/20/2022
Last updated
05/17/2023
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