Provider Demographics
NPI:1083841118
Name:MURN AND MUMM FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MURN AND MUMM FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-252-8800
Mailing Address - Street 1:1706 11TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1200
Mailing Address - Country:US
Mailing Address - Phone:320-252-8800
Mailing Address - Fax:320-202-1014
Practice Address - Street 1:1706 11TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1200
Practice Address - Country:US
Practice Address - Phone:320-252-8800
Practice Address - Fax:320-202-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9221122300000X
MN10166122300000X
MND12650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty