Provider Demographics
NPI:1609064005
Name:RUNNELS, ERIKA LYCHUNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:LYCHUNN
Last Name:RUNNELS
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 1:5600 S WILLOW DR STE 111
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-4721
Mailing Address - Country:US
Mailing Address - Phone:713-497-5152
Mailing Address - Fax:
Practice Address - Street 1:5600 S WILLOW DR STE 111
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-4721
Practice Address - Country:US
Practice Address - Phone:713-497-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3265936Medicaid