Provider Demographics
NPI:1598783037
Name:RUNNE, BARBARA J (DDS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:RUNNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BRENNAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60146
Mailing Address - Country:US
Mailing Address - Phone:815-522-3541
Mailing Address - Fax:815-522-2107
Practice Address - Street 1:105 BRENNAN DRIVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:IL
Practice Address - Zip Code:60146
Practice Address - Country:US
Practice Address - Phone:815-522-3541
Practice Address - Fax:815-522-2107
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003541OtherPUBLIC AID