Provider Demographics
NPI:1720003528
Name:MURPHY, SHANE T (DDS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:T
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 1:330 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7369
Mailing Address - Country:US
Mailing Address - Phone:907-561-4047
Mailing Address - Fax:907-562-9856
Practice Address - Street 1:330 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7369
Practice Address - Country:US
Practice Address - Phone:907-561-4047
Practice Address - Fax:907-562-9856
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK01630417OtherUNITED CONCORDIA PROVIDER
AKDD1741Medicaid
AK1131OtherDENTAL LICENSE #
AK1131OtherDENTAL LICENSE #