Provider Demographics
NPI:1932275872
Name:RUNNE, JUDITH ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:RUNNE
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 1:1644 OAKPARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5509
Mailing Address - Country:US
Mailing Address - Phone:815-229-7678
Mailing Address - Fax:
Practice Address - Street 1:351 WILEY
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:IL
Practice Address - Zip Code:61353
Practice Address - Country:US
Practice Address - Phone:815-627-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice