Provider Demographics
NPI:1821310673
Name:MURRAY, JASON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:MURRAY
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 1:38 WESTPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6224
Mailing Address - Country:US
Mailing Address - Phone:612-730-7877
Mailing Address - Fax:
Practice Address - Street 1:12000 SE 82ND AVE STE 1145
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7735
Practice Address - Country:US
Practice Address - Phone:503-653-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60174477122300000X
MND126631223G0001X
ORD95231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist