Provider Demographics
NPI:1053415174
Name:MURPHY, ANDREW G (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:MURPHY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052
Mailing Address - Country:US
Mailing Address - Phone:318-872-1557
Mailing Address - Fax:318-872-3064
Practice Address - Street 1:126 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052
Practice Address - Country:US
Practice Address - Phone:318-872-1557
Practice Address - Fax:318-872-3064
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38631223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1838632Medicaid