Provider Demographics
NPI:1275116618
Name:MURDOCK, KYLE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:MURDOCK
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 1:3545 GRANDVIEW PKWY APT 1-306
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1928
Mailing Address - Country:US
Mailing Address - Phone:843-345-0527
Mailing Address - Fax:
Practice Address - Street 1:1316 SOMERVILLE RD SE STE 2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4309
Practice Address - Country:US
Practice Address - Phone:256-350-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006873-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice