Healthcare Provider Details

I. General information

NPI: 1679554315
Provider Name (Legal Business Name): KEVIN J MURPHY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR 45TH MEDICAL GROUP
PATRICK AFB FL
32925-3606
US

IV. Provider business mailing address

426 STONEHENGE CIR
ROCKLEDGE FL
32955-4746
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-8270
  • Fax:
Mailing address:
  • Phone: 321-433-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019022699
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: