Provider Demographics
NPI:1528059979
Name:DRS KANYUSIK WIEMERS & RUNCK PA
Entity type:Organization
Organization Name:DRS KANYUSIK WIEMERS & RUNCK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANYUSIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:507-388-2989
Mailing Address - Street 1:120 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3501
Mailing Address - Country:US
Mailing Address - Phone:507-388-2989
Mailing Address - Fax:507-388-2985
Practice Address - Street 1:120 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3501
Practice Address - Country:US
Practice Address - Phone:507-388-2989
Practice Address - Fax:507-388-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty