MEDICARE: MURRIN DENTAL MANAGEMENT LLC

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	1223G0001X	General Practice Dentistry	DN15642	FL

General Provider Information

NPI Number	:	1013200682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURRIN DENTAL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	10157 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5609
Country	:	US
Telephone Number	:	772-337-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	10157 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5609
Country	:	US
Telephone Number	:	772-337-1127
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. EILEEN MURRIN
Credential	:
Telephone Number	:	772-337-1127

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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