Provider Demographics
NPI:1396802740
Name:RUNDQUIST, KATHLEEN LOGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOGAN
Last Name:RUNDQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 MORGAN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1024
Mailing Address - Country:US
Mailing Address - Phone:612-925-3559
Mailing Address - Fax:
Practice Address - Street 1:50 W NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4524
Practice Address - Country:US
Practice Address - Phone:952-892-6010
Practice Address - Fax:952-891-0203
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND106821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice