Provider Demographics
NPI:1417154741
Name:OETTINGER, MURR ROY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MURR
Middle Name:ROY
Last Name:OETTINGER
Suffix:JR
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 1:2979 RIVER ROAD WEST
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-0729
Mailing Address - Country:US
Mailing Address - Phone:804-556-2540
Mailing Address - Fax:
Practice Address - Street 1:2979 RIVER ROAD WEST
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-0729
Practice Address - Country:US
Practice Address - Phone:804-556-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010043501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401004350OtherDENTAL LICENSE
VAAO6197493OtherBND#