Provider Demographics
NPI:1104934702
Name:MURRAY, THEODORE ALEXANDER JR (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ALEXANDER
Last Name:MURRAY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:A
Other - Last Name:MURRAY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1534 FIFTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1818
Mailing Address - Country:US
Mailing Address - Phone:415-453-7162
Mailing Address - Fax:415-453-7869
Practice Address - Street 1:1534 FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1818
Practice Address - Country:US
Practice Address - Phone:415-453-7162
Practice Address - Fax:415-453-7869
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist