Provider Demographics
NPI:1790961837
Name:RUNCK, MERLE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERLE
Middle Name:EDWARD
Last Name:RUNCK
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 1:138 GERE CT
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4186
Mailing Address - Country:US
Mailing Address - Phone:719-276-2527
Mailing Address - Fax:719-269-8154
Practice Address - Street 1:138 GERE CT
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4186
Practice Address - Country:US
Practice Address - Phone:719-276-2527
Practice Address - Fax:719-269-8154
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice