Provider Demographics
NPI:1932392891
Name:MARTHA M. MURPHY DDS LLC
Entity Type:Organization
Organization Name:MARTHA M. MURPHY DDS LLC
Other - Org Name:LAKESIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAURI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:301-990-7778
Mailing Address - Street 1:100 LAKEFOREST BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2609
Mailing Address - Country:US
Mailing Address - Phone:301-990-7778
Mailing Address - Fax:
Practice Address - Street 1:100 LAKEFOREST BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2609
Practice Address - Country:US
Practice Address - Phone:301-990-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD77351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty