Provider Demographics
NPI:1699797134
Name:MURPHY, MICHAEL ROBERT JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MURPHY
Suffix:JR
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-0010
Mailing Address - Country:US
Mailing Address - Phone:715-339-3021
Mailing Address - Fax:715-339-3022
Practice Address - Street 1:605 PETERSON DR
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1430
Practice Address - Country:US
Practice Address - Phone:715-339-3021
Practice Address - Fax:715-339-3022
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087181223G0001X
WI6619-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice