Provider Demographics
NPI:1407844871
Name:MORGAN, THOMAS B (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16670 FRANKLIN TRL SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2924
Mailing Address - Country:US
Mailing Address - Phone:952-447-4611
Mailing Address - Fax:952-447-4660
Practice Address - Street 1:16670 FRANKLIN TRL SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2924
Practice Address - Country:US
Practice Address - Phone:952-447-4611
Practice Address - Fax:952-447-4660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice