Provider Demographics
NPI:1871855387
Name:MANSFIELD DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:MANSFIELD DENTAL CLINIC LLC
Other - Org Name:ANDREW G MURPHY DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-872-1557
Mailing Address - Street 1:126 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2600
Mailing Address - Country:US
Mailing Address - Phone:318-872-1557
Mailing Address - Fax:318-872-3064
Practice Address - Street 1:126 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2600
Practice Address - Country:US
Practice Address - Phone:318-872-1557
Practice Address - Fax:318-872-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty