Wayne Bernell Murdock, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1719 Issued in ID

Practice address

2205 Channing Way
Suite a
Idaho Falls, ID 83404-8016

Phone

(208) 529-4484

Fax

(208) 523-4441

NPI assigned

Aug 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Foothills Dental Care

  • Dental Clinic/Center
  • Idaho Falls, ID
  • NPI 1275619090
  NPD (past) Authorized official
• Foothills Dental Care, PLLC

  dba RiverWest Dental

  • Dentist
  • Idaho Falls, ID
  • NPI 1205175668
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952317703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 GEORGIA LN",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834067812",
            "telephone_number": "208-529-0868",
            "fax_number": "208-523-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY",
            "address_2": "SUITE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-4484",
            "fax_number": "208-523-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MURDOCK",
        "first_name": "WAYNE",
        "middle_name": "BERNELL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID",
            "identifier": "6D915",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isabel Amia Murdock
• Jonathan Riley Murdock, LCSW
• Tasha Murdock
• Tina Marie Murdock, PA-C
• Tyson R Murdock, D.M.D
• Joshua M Murphy, DMD
• Marcus Murphy, MD
• Rick Murphy, DC
• David Paul Murray, DO
• MVH Anesthesia, LLC

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.