=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295932127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENT MURPHY D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 04/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5625 S 62ND ST
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68516-3560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-202-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11725 VANDERVIEW RD
-----------------------------------------------------
City | HICKMAN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68372-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-202-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6699
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------