Provider Demographics
NPI:1760017263
Name:GOLD HILL FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:GOLD HILL FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMC
Authorized Official - Phone:541-878-2115
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:SHADY COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97539-1150
Mailing Address - Country:US
Mailing Address - Phone:541-878-2115
Mailing Address - Fax:541-878-2117
Practice Address - Street 1:492 2ND AVE
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:OR
Practice Address - Zip Code:97525-5536
Practice Address - Country:US
Practice Address - Phone:541-855-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty