Healthcare Provider Details

I. General information

NPI: 1700047313
Provider Name (Legal Business Name): SHELLEY IRVING MURPHY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLEY DIANE IRVING DMD

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 EXECUTIVE PARK RD STE B
HILTON HEAD ISLAND SC
29928-4703
US

IV. Provider business mailing address

9 EXECUTIVE PARK RD STE B
HILTON HEAD ISLAND SC
29928-4703
US

V. Phone/Fax

Practice location:
  • Phone: 843-842-2300
  • Fax: 843-842-3065
Mailing address:
  • Phone: 843-842-2300
  • Fax: 843-842-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD9100
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6943
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: