Provider Demographics
NPI:1538315296
Name:DOUGLAS G. RUNDLE, D.M.D, P.C
Entity Type:Organization
Organization Name:DOUGLAS G. RUNDLE, D.M.D, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-467-7181
Mailing Address - Street 1:10121 N NEVADA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3120
Mailing Address - Country:US
Mailing Address - Phone:509-467-7181
Mailing Address - Fax:509-464-0953
Practice Address - Street 1:10121 N NEVADA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3120
Practice Address - Country:US
Practice Address - Phone:509-467-7181
Practice Address - Fax:509-464-0953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS G. RUNDLE, D.M.D., P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-13
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty