Provider Demographics
NPI:1053420687
Name:MURPHY, LISA MARIE (RDH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1566
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:AZ
Mailing Address - Zip Code:85544-1566
Mailing Address - Country:US
Mailing Address - Phone:928-476-4054
Mailing Address - Fax:
Practice Address - Street 1:300 W AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-3607
Practice Address - Country:US
Practice Address - Phone:928-474-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6025124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist