Provider Demographics
NPI:1902817513
Name:MURDOCH, LAMONT HALLDOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAMONT
Middle Name:HALLDOR
Last Name:MURDOCH
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 1:5525 VALLEY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:VALLYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036
Mailing Address - Country:US
Mailing Address - Phone:509-448-9514
Mailing Address - Fax:509-448-9514
Practice Address - Street 1:1118 S PERRY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-534-2232
Practice Address - Fax:509-532-8636
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE7288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049630Medicaid