Provider Demographics
NPI:1790862696
Name:BRIAN A MCMURTRY DDS PA
Entity Type:Organization
Organization Name:BRIAN A MCMURTRY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-392-3883
Mailing Address - Street 1:10816 BLACK DOG LN, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214
Mailing Address - Country:US
Mailing Address - Phone:704-392-3883
Mailing Address - Fax:704-392-3893
Practice Address - Street 1:10816 BLACK DOG LN, SUITE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214
Practice Address - Country:US
Practice Address - Phone:704-392-3883
Practice Address - Fax:704-392-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty