Provider Demographics
NPI:1578138103
Name:MURDOCK, RAVEN ALLIANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:ALLIANDRA
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 SWEET BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1956
Mailing Address - Country:US
Mailing Address - Phone:317-657-0419
Mailing Address - Fax:
Practice Address - Street 1:2302 S DIXON RD STE 125
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6429
Practice Address - Country:US
Practice Address - Phone:765-345-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013612A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice