Provider Demographics
NPI:1790771673
Name:RUNDE, GERALD P (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:P
Last Name:RUNDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N GARRETT ST
Mailing Address - Street 2:P.O. BOX 215
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-1132
Mailing Address - Country:US
Mailing Address - Phone:217-857-3201
Mailing Address - Fax:217-857-6007
Practice Address - Street 1:206 N. PEARL ST.
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-0215
Practice Address - Country:US
Practice Address - Phone:217-857-3201
Practice Address - Fax:217-857-6007
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist