Provider Demographics
NPI:1104862275
Name:MURDOCK, MARK BROOKS (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:BROOKS
Last Name:MURDOCK
Suffix:
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 1:698 W 700 S
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2875
Mailing Address - Country:US
Mailing Address - Phone:435-723-0629
Mailing Address - Fax:
Practice Address - Street 1:30 E 700 S
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3235
Practice Address - Country:US
Practice Address - Phone:435-734-2248
Practice Address - Fax:435-723-0778
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4931937-99221223G0001X
UT4931937-89031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice