Provider Demographics
NPI:1154420537
Name:MURRY, MITCH
Entity type:Individual
Prefix:
First Name:MITCH
Middle Name:
Last Name:MURRY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:MITCHELL
Other - Last Name:MURRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:719 MCKENZIE RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MESCALERO SERVICE UNIT INDIAN HEALTH SERVICE
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-0210
Practice Address - Country:US
Practice Address - Phone:505-464-4441
Practice Address - Fax:505-464-4422
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PIDS0000Medicare UPIN