Provider Demographics
NPI:1487796132
Name:MURRAY, WM JACOB III (DMD)
Entity type:Individual
Prefix:DR
First Name:WM JACOB
Middle Name:
Last Name:MURRAY
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:JACOB
Other - Last Name:MURRAY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:100 CHARLES ST S
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5430
Mailing Address - Country:US
Mailing Address - Phone:617-357-7357
Mailing Address - Fax:
Practice Address - Street 1:100 CHARLES ST S
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5430
Practice Address - Country:US
Practice Address - Phone:617-357-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice