Healthcare Provider Details

I. General information

NPI: 1336920321
Provider Name (Legal Business Name): GABRIEL MURPHY, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7119 NORTH AVE
OAK PARK IL
60302-1002
US

IV. Provider business mailing address

7119 NORTH AVE
OAK PARK IL
60302-1002
US

V. Phone/Fax

Practice location:
  • Phone: 708-934-9379
  • Fax:
Mailing address:
  • Phone: 708-934-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIEL MURPHY
Title or Position: OWNER
Credential: DMD
Phone: 423-457-4512