Provider Demographics
NPI:1215036710
Name:RUNYON, CARL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:R
Last Name:RUNYON
Suffix:
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 1:150 ROLLING RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-9655
Mailing Address - Country:US
Mailing Address - Phone:925-372-6101
Mailing Address - Fax:
Practice Address - Street 1:1855 SAN MIGUEL DR STE 25
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5298
Practice Address - Country:US
Practice Address - Phone:925-934-5565
Practice Address - Fax:925-934-6003
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADSO374900Medicare ID - Type Unspecified
CAU26187Medicare UPIN