Provider Demographics
NPI:1750079737
Name:TIM RUNCO DMD PC
Entity type:Organization
Organization Name:TIM RUNCO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUNCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-200-2614
Mailing Address - Street 1:6502B STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1006
Mailing Address - Country:US
Mailing Address - Phone:412-200-2614
Mailing Address - Fax:412-200-2641
Practice Address - Street 1:6502B STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1006
Practice Address - Country:US
Practice Address - Phone:412-200-2614
Practice Address - Fax:412-200-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty