Provider Demographics
NPI:1093539892
Name:ERIC J RUNYON DDS LLC
Entity type:Organization
Organization Name:ERIC J RUNYON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-401-3616
Mailing Address - Street 1:13041 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2386
Mailing Address - Country:US
Mailing Address - Phone:314-401-3616
Mailing Address - Fax:
Practice Address - Street 1:103 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2480
Practice Address - Country:US
Practice Address - Phone:816-331-9100
Practice Address - Fax:816-331-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty