Provider Demographics
NPI:1750588190
Name:MURDOCK, CHAD JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JOSEPH
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 TENDERFOOT HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7393
Mailing Address - Country:US
Mailing Address - Phone:719-426-2653
Mailing Address - Fax:719-249-7550
Practice Address - Street 1:1230 TENDERFOOT HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7393
Practice Address - Country:US
Practice Address - Phone:719-426-2653
Practice Address - Fax:719-249-7550
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6315085-99221223G0001X
CO92891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80504213Medicaid