Provider Demographics
NPI:1851140628
Name:MCMURRAY, MALLORY (DDS)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:MCMURRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S MILLER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9024
Mailing Address - Country:US
Mailing Address - Phone:740-965-2451
Mailing Address - Fax:
Practice Address - Street 1:450 S MILLER DR STE 200
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9024
Practice Address - Country:US
Practice Address - Phone:740-965-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0275171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice