Provider Demographics
NPI:1518140698
Name:NICHOLAS C. MURPHY, DMD, PSC
Entity Type:Organization
Organization Name:NICHOLAS C. MURPHY, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEROAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-769-3858
Mailing Address - Street 1:1107 CROWN POINTE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7123
Mailing Address - Country:US
Mailing Address - Phone:270-769-3858
Mailing Address - Fax:
Practice Address - Street 1:1107 CROWN POINTE DR
Practice Address - Street 2:SUITE F
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7123
Practice Address - Country:US
Practice Address - Phone:270-769-3858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60062411Medicaid
KY60002110Medicaid
KY60072972Medicaid