Provider Demographics
NPI:1609212687
Name:RUNDLE, DOUGLAS GREGG (DMD, MPH, MS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GREGG
Last Name:RUNDLE
Suffix:
Gender:M
Credentials:DMD, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000067071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics