Provider Demographics
NPI:1679827141
Name:RUNGE, LINDA N (RDH)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:N
Last Name:RUNGE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3127
Mailing Address - Country:US
Mailing Address - Phone:315-424-0800
Mailing Address - Fax:315-424-1928
Practice Address - Street 1:603 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3127
Practice Address - Country:US
Practice Address - Phone:315-424-0800
Practice Address - Fax:315-424-1928
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012533-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist