Provider Demographics
NPI:1275638355
Name:MUNN, JOHN ALDEN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALDEN
Last Name:MUNN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29652-2507
Mailing Address - Country:US
Mailing Address - Phone:864-877-7527
Mailing Address - Fax:864-877-3015
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1653
Practice Address - Country:US
Practice Address - Phone:864-877-7527
Practice Address - Fax:864-877-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice