Provider Demographics
NPI:1689670499
Name:MURRAY, LISA J (DMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2219
Mailing Address - Country:US
Mailing Address - Phone:978-468-4494
Mailing Address - Fax:978-468-9741
Practice Address - Street 1:34 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2219
Practice Address - Country:US
Practice Address - Phone:978-468-4494
Practice Address - Fax:978-468-9741
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11330OtherBCBS PROVIDER NUMBER