Healthcare Provider Details

I. General information

NPI: 1366708653
Provider Name (Legal Business Name): JUNE MURAKARU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # GC-2133
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH STREET GC-2133
AUGUSTA GA
30912
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2716
  • Fax:
Mailing address:
  • Phone: 706-721-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN014468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: