Provider Demographics
NPI:1619062601
Name:MURPHY, AARON B (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:B
Last Name:MURPHY
Suffix:
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 1:1031 W. THIRD ST.
Mailing Address - Street 2:PO BOX 57
Mailing Address - City:IMBODEN
Mailing Address - State:AR
Mailing Address - Zip Code:72434
Mailing Address - Country:US
Mailing Address - Phone:870-869-1042
Mailing Address - Fax:870-869-1043
Practice Address - Street 1:1031 W. THIRD ST.
Practice Address - Street 2:
Practice Address - City:IMBODEN
Practice Address - State:AR
Practice Address - Zip Code:72434
Practice Address - Country:US
Practice Address - Phone:870-869-1042
Practice Address - Fax:870-869-1043
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y076OtherBLUE CROSS BLUE SHIELD
1652252OtherUNITED CONCORDIA