Provider Demographics
NPI:1285700641
Name:MURRAY, TED JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:JOSEPH
Last Name:MURRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2892
Mailing Address - Country:US
Mailing Address - Phone:563-556-2711
Mailing Address - Fax:563-556-8017
Practice Address - Street 1:4200 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2892
Practice Address - Country:US
Practice Address - Phone:563-556-2711
Practice Address - Fax:563-556-8017
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA62541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA687386OtherTRICARE
IA177923OtherDELTA
IA0152728Medicaid
IA17792OtherBLUE CROSS BLUE SHIELD
IA687383OtherUNITED CONCORDIA