Individual provider Active NPI

John Douglass Murray, DDS

  • Dentist
  • Saranac Lake, NY
National Provider Identifier
1790992972
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
052470 Issued in NY
Practice address
16 Church St
Saranac Lake, NY 12983-1802
Phone
(518) 891-1205
Fax
(518) 891-0413
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 052470 NY Primary

Addresses

Primary practice location

16 Church St
Saranac Lake, NY 12983-1802

Mailing address

16 Church St
Saranac Lake, NY 12983-1802
Phone (518) 891-1205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150713002378 NY Order and Referring Only - DentistPractitioner - Dentist 4486967908

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790992972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 CHURCH ST",
            "city": "SARANAC LAKE",
            "state": "NY",
            "postal_code": "129831802",
            "telephone_number": "518-891-1205",
            "fax_number": "518-891-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 CHURCH ST",
            "city": "SARANAC LAKE",
            "state": "NY",
            "postal_code": "129831802",
            "telephone_number": "518-891-1205",
            "fax_number": "518-891-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MURRAY",
        "first_name": "JOHN",
        "middle_name": "DOUGLASS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "052470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saranac Lake, NY

Sources for this page

Verify at the official NPI Registry.