Provider Demographics
NPI:1912458522
Name:PETER R MURCHIE DDS
Entity Type:Organization
Organization Name:PETER R MURCHIE DDS
Other - Org Name:GOOCHLAND DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-784-4624
Mailing Address - Street 1:115 BROAD STREET RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2218
Mailing Address - Country:US
Mailing Address - Phone:804-784-4624
Mailing Address - Fax:804-784-4905
Practice Address - Street 1:115 BROAD STREET RD
Practice Address - Street 2:SUITE C
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-2218
Practice Address - Country:US
Practice Address - Phone:804-784-4624
Practice Address - Fax:804-784-4905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty