Basic Information
| Provider Information | |||||||||
| NPI: | 1962649186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2074S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976013372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418518110 | ||||||||
| FaxNumber: | 5418802091 | ||||||||
| Practice Location | |||||||||
| Address1: | 339 3RD ST W | ||||||||
| Address2: | |||||||||
| City: | HARDIN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590341703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066653300 | ||||||||
| FaxNumber: | 4066654290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2009 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D9828 | OR | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 170061 | 05 | OR | MEDICAID |