Healthcare Provider Details

I. General information

NPI: 1750551297
Provider Name (Legal Business Name): JOHN A MURRELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BLUE RIDGE RD STE 310
RALEIGH NC
27607-6475
US

IV. Provider business mailing address

2605 BLUE RIDGE RD STE 310
RALEIGH NC
27607-6475
US

V. Phone/Fax

Practice location:
  • Phone: 919-510-4959
  • Fax: 919-510-7989
Mailing address:
  • Phone: 919-510-4959
  • Fax: 919-510-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6248
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number29390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: