Provider Demographics
NPI:1437351285
Name:MURRAY, SHAWN M (CDT, LD)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:M
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CDT, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 W 12TH ST.
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439
Mailing Address - Country:US
Mailing Address - Phone:541-997-3344
Mailing Address - Fax:541-997-9103
Practice Address - Street 1:1647 W 12TH ST.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-997-3344
Practice Address - Fax:541-997-9103
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0516846206122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist