Provider Demographics
NPI:1801394432
Name:MURDOCK AND MURDOCK, DDS, MS, PA
Entity type:Organization
Organization Name:MURDOCK AND MURDOCK, DDS, MS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:704-821-8008
Mailing Address - Street 1:6400 WEDDINGTON MONROE RD STE D
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6295
Mailing Address - Country:US
Mailing Address - Phone:704-821-8008
Mailing Address - Fax:
Practice Address - Street 1:6400 WEDDINGTON MONROE RD STE D
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:NC
Practice Address - Zip Code:28104-6295
Practice Address - Country:US
Practice Address - Phone:704-821-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty