=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437351285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN M MURRAY C.D.T., L.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1647 W 12TH ST.
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-997-3344
-----------------------------------------------------
Fax | 541-997-9103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1647 W 12TH ST.
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-997-3344
-----------------------------------------------------
Fax | 541-997-9103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122400000X
-----------------------------------------------------
Taxonomy Name | Denturist
-----------------------------------------------------
License Number | 0516846206
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------