Healthcare Provider Details

I. General information

NPI: 1376613505
Provider Name (Legal Business Name): MURRAY SPAIN JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 W CHEROKEE ST
BLACKSBURG SC
29702-9221
US

IV. Provider business mailing address

3634 SOUTH PLZA TRAIL
VIRGINIA BEACH VA
23452
US

V. Phone/Fax

Practice location:
  • Phone: 864-839-0034
  • Fax: 864-839-0064
Mailing address:
  • Phone: 757-498-9510
  • Fax: 757-498-6943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401007006
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2761
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: