Provider Demographics
NPI:1396123899
Name:MURPHY, JANETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JANETTE
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2044 CHATSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2716
Mailing Address - Country:US
Mailing Address - Phone:619-223-6767
Mailing Address - Fax:619-223-6960
Practice Address - Street 1:2044 CHATSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2716
Practice Address - Country:US
Practice Address - Phone:619-223-6767
Practice Address - Fax:619-223-6960
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7565920001Medicare NSC