Healthcare Provider Details

I. General information

NPI: 1790149052
Provider Name (Legal Business Name): KEVIN GEORGE MURPHY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 FALLS RD #202
BALTIMORE MD
21209-2498
US

IV. Provider business mailing address

6080 FALLS RD #202
BALTIMORE MD
21209-2498
US

V. Phone/Fax

Practice location:
  • Phone: 410-372-0202
  • Fax: 410-372-0311
Mailing address:
  • Phone: 410-372-0202
  • Fax: 410-372-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9124
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9124
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: