Provider Demographics
NPI:1790956720
Name:R. SCOTT MURPHY, DDS, MD, INC.
Entity Type:Organization
Organization Name:R. SCOTT MURPHY, DDS, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:304-522-3200
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-522-3200
Mailing Address - Fax:304-522-3401
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-522-3200
Practice Address - Fax:304-522-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2301931Medicaid
WV4003041000Medicaid