Provider Demographics
NPI:1881684462
Name:RUNYON, RODNEY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DEAN
Last Name:RUNYON
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 1:614 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6317
Mailing Address - Country:US
Mailing Address - Phone:615-451-3833
Mailing Address - Fax:
Practice Address - Street 1:614 COMMONS DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6317
Practice Address - Country:US
Practice Address - Phone:615-451-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS69231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0005997Medicare ID - Type Unspecified