MEDICARE: DR. CASEY MURDOCK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2309	MT

General Provider Information

NPI Number	:	1013172915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY MURDOCK DMD

Provider Business Mailing Address
First Line	:	791 E 600 N
Second Line	:
City	:	FIRTH
State	:	ID
Zip	:	83236-1224
Country	:	US
Telephone Number	:	208-346-6284
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 MAIN ST
Second Line	:	SUITE # 14
City	:	BILLINGS
State	:	MT
Zip	:	59105-3359
Country	:	US
Telephone Number	:	406-259-0110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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