MEDICARE: MR. MARK BROOKS MURDOCK D.D.S

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	4931937-9922	UT
2	1223G0001X	General Practice Dentistry	4931937-8903	UT

General Provider Information

NPI Number	:	1104862275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK BROOKS MURDOCK D.D.S

Provider Business Mailing Address
First Line	:	698 W 700 S
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-2875
Country	:	US
Telephone Number	:	435-723-0629
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 E 700 S
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3235
Country	:	US
Telephone Number	:	435-734-2248
Fax Number	:	435-723-0778

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. MARK BROOKS MURDOCK D.D.S” Practice Location

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