MEDICARE: VINCENT JOHN 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	541572469	VA

General Provider Information

NPI Number	:	1316163041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT JOHN MURRAY DDS

Provider Business Mailing Address
First Line	:	5 ROCK POINTE LN
Second Line	:	SUITE 100
City	:	WARRENTON
State	:	VA
Zip	:	20186-2632
Country	:	US
Telephone Number	:	540-349-0056
Fax Number	:	540-349-0013

Provider Business Practice Location Address
First Line	:	1209 N FRASER ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-2853
Country	:	US
Telephone Number	:	435-462-2738
Fax Number	:	843-546-7777

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	10/16/2023

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