MEDICARE: DR. JASON L MURRAY 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	122300000X	Dentist	DE60174477	WA
2	1223G0001X	General Practice Dentistry	D12663	MN
3	1223G0001X	General Practice Dentistry	D9523	OR

General Provider Information

NPI Number	:	1821310673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON L MURRAY D.D.S.

Provider Business Mailing Address
First Line	:	38 WESTPOINTE DR
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-6224
Country	:	US
Telephone Number	:	612-730-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 SE 82ND AVE STE 1145
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-7735
Country	:	US
Telephone Number	:	503-653-9870
Fax Number	:

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

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	02/23/2011

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