Provider Demographics
NPI:1093827610
Name:MURPHY, MICHAEL TIMOTHY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:MURPHY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CUMBERLAND FALLS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2739
Mailing Address - Country:US
Mailing Address - Phone:606-528-9402
Mailing Address - Fax:606-528-9404
Practice Address - Street 1:1400 CUMBERLAND FALLS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2739
Practice Address - Country:US
Practice Address - Phone:606-528-9402
Practice Address - Fax:606-528-9404
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6468204E00000X, 1223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60064680Medicaid
KY64064686Medicaid
KY1256605Medicare ID - Type UnspecifiedCOBIN OFFICE
KY60064680Medicaid
KY64064686Medicaid