Provider Demographics
NPI:1720102627
Name:MURN, THOMAS GREGORY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GREGORY
Last Name:MURN
Suffix:JR
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 1:1706 11TH AVE N
Mailing Address - Street 2:DOCTORS PARK
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:
Practice Address - Street 1:1706 11TH AVE N
Practice Address - Street 2:DOCTORS PARK
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:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN92211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice