Provider Demographics
NPI:1932166816
Name:MURRAY, LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
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 1:6230 HIGHWAY 65 NE
Mailing Address - Street 2:#105
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5107
Mailing Address - Country:US
Mailing Address - Phone:763-571-5497
Mailing Address - Fax:
Practice Address - Street 1:6230 HIGHWAY 65 NE
Practice Address - Street 2:#105
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5107
Practice Address - Country:US
Practice Address - Phone:763-571-5497
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice