Healthcare Provider Details

I. General information

NPI: 1003862194
Provider Name (Legal Business Name): DAN C. MURPHY D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W EMPIRE ST
GRASS VALLEY CA
95945-7510
US

IV. Provider business mailing address

115 W EMPIRE ST
GRASS VALLEY CA
95945-7510
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-1981
  • Fax: 530-272-6564
Mailing address:
  • Phone: 530-272-1981
  • Fax: 530-272-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21176
License Number StateCA

VIII. Authorized Official

Name: DR. DAN C. MURPHY
Title or Position: ORTHODONTIST
Credential: D.D.S.
Phone: 530-272-1981