Provider Demographics
NPI:1336276161
Name:RUNCO, TIMOTHY I (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:I
Last Name:RUNCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 MCKINNEY LANE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220
Mailing Address - Country:US
Mailing Address - Phone:412-937-9070
Mailing Address - Fax:412-937-1215
Practice Address - Street 1:1165 MCKINNEY LANE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220
Practice Address - Country:US
Practice Address - Phone:412-937-9070
Practice Address - Fax:412-937-1215
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024797-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice