Provider Demographics
NPI:1235602137
Name:WILLIAM J RUNNE, DDS LLC
Entity Type:Organization
Organization Name:WILLIAM J RUNNE, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-397-3554
Mailing Address - Street 1:4035 MORSAY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4875
Mailing Address - Country:US
Mailing Address - Phone:815-397-3554
Mailing Address - Fax:815-312-5985
Practice Address - Street 1:4035 MORSAY DR STE 2
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4875
Practice Address - Country:US
Practice Address - Phone:815-397-3554
Practice Address - Fax:815-312-5985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty