Provider Demographics
NPI:1912501990
Name:BSI MURRAY DENTAL LLC
Entity Type:Organization
Organization Name:BSI MURRAY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-266-8141
Mailing Address - Street 1:168 E 5900 S # 101
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7287
Mailing Address - Country:US
Mailing Address - Phone:801-266-8141
Mailing Address - Fax:801-266-3014
Practice Address - Street 1:168 E 5900 S # 101
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7287
Practice Address - Country:US
Practice Address - Phone:801-266-8141
Practice Address - Fax:801-266-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty