MEDICARE: TESHANA NATE MURRAY DDS

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	20825	TX

General Provider Information

NPI Number	:	1063575082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESHANA NATE MURRAY DDS

Provider Business Mailing Address
First Line	:	3835 AERIAL BROOK TRL
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-8755
Country	:	US
Telephone Number	:	512-929-7888
Fax Number	:	512-929-8454

Provider Business Practice Location Address
First Line	:	1144 AIRPORT BLVD STE 240
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-3165
Country	:	US
Telephone Number	:	512-929-7888
Fax Number	:	512-929-8091

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/09/2007

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