Provider Demographics
NPI:1659542603
Name:RUNDLE, KENNETH B (D D S)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:RUNDLE
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 CALUMET AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2545
Mailing Address - Country:US
Mailing Address - Phone:219-836-7684
Mailing Address - Fax:219-836-7687
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2545
Practice Address - Country:US
Practice Address - Phone:219-836-7684
Practice Address - Fax:219-835-7687
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010884B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist