Provider Demographics
NPI:1265584544
Name:MURRAY, KIM H (DDS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:H
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W OLLIE ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2626
Mailing Address - Country:US
Mailing Address - Phone:325-247-4213
Mailing Address - Fax:325-247-4213
Practice Address - Street 1:108 W OLLIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2626
Practice Address - Country:US
Practice Address - Phone:325-247-4213
Practice Address - Fax:325-247-4213
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD14961OtherBLUE CROSS BLUE SHIELD