Healthcare Provider Details

I. General information

NPI: 1609104371
Provider Name (Legal Business Name): KEVIN VANCE MURPHY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

1615 MICHIGAN AVE
BALDWIN MI
49304-7984
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-1608
  • Fax: 231-689-3162
Mailing address:
  • Phone: 231-745-5051
  • Fax: 231-745-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901012979
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: