Provider Demographics
NPI:1407250475
Name:IAN MURRAY, D.M.D., INC.
Entity Type:Organization
Organization Name:IAN MURRAY, D.M.D., INC.
Other - Org Name:MISSION TRAILS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-255-0046
Mailing Address - Street 1:6902 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1563
Mailing Address - Country:US
Mailing Address - Phone:619-582-9700
Mailing Address - Fax:619-583-6932
Practice Address - Street 1:6902 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1563
Practice Address - Country:US
Practice Address - Phone:619-582-9700
Practice Address - Fax:619-583-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881826097OtherINDIVIDUAL
CA1881032175OtherINDIVIDUAL