Provider Demographics
NPI:1275377293
Name:RUNKLE, TAYLOR RENEE (DMD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:RUNKLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SCHOLL RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7270
Mailing Address - Country:US
Mailing Address - Phone:610-256-5661
Mailing Address - Fax:
Practice Address - Street 1:1001 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-9211
Practice Address - Country:US
Practice Address - Phone:610-562-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist