Provider Demographics
NPI:1043216237
Name:MURPHY, PETER MICHAEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:MURPHY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROFESSIONAL VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1569
Mailing Address - Country:US
Mailing Address - Phone:843-770-9904
Mailing Address - Fax:843-770-9906
Practice Address - Street 1:10 PROFESSIONAL VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1569
Practice Address - Country:US
Practice Address - Phone:843-770-9904
Practice Address - Fax:843-770-9906
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
SC3719 - GENERAL DENTI1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3719Medicaid