MEDICARE: VENT STEPHEN MURPHY D.D.S., M.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	1223P0221X	Pediatric Dentistry	2822	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	632700	OTHER		CONCORDIA
2	58456	OTHER		BCBS

General Provider Information

NPI Number	:	1134324296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENT STEPHEN MURPHY D.D.S., M.S.

Provider Business Mailing Address
First Line	:	603 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-785-5437
Fax Number	:	479-785-5534

Provider Business Practice Location Address
First Line	:	603 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-785-5437
Fax Number	:	479-785-5534

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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Directions to “ VENT STEPHEN MURPHY D.D.S., M.S.” Practice Location

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