Basic Information
| Provider Information | |||||||||
| NPI: | 1396358214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | MCCURDY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3268 GREYLING DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586170620 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3268 GREYLING DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586170620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2020 | ||||||||
| LastUpdateDate: | 08/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 159725 | FL | N | Dental Providers | Dentist | General Practice | 1223G0001X | 105376 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.