Individual
DR. WAYNE BERNELL MURDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2205 CHANNING WAY, SUITE A, IDAHO FALLS, ID 83404-8016
(208) 529-4484
(208) 523-4441
Mailing address
3955 GEORGIA LN, AMMON, ID 83406-7812
(208) 529-0868
(208) 523-4441
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1719
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6D915
BLUE CROSS ID
ID
Enumeration date
08/01/2006
Last updated
07/08/2007
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