Healthcare Provider Details

I. General information

NPI: 1942313630
Provider Name (Legal Business Name): FRANK RUNCO DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HAMPTON VILLAGE PLZ SUITE 262
SAINT LOUIS MO
63109-2111
US

IV. Provider business mailing address

16 HAMPTON VILLAGE PLZ SUITE 262
SAINT LOUIS MO
63109-2111
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-4680
  • Fax: 314-481-4014
Mailing address:
  • Phone: 314-352-4680
  • Fax: 314-481-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number14387
License Number StateMO

VIII. Authorized Official

Name: DR. FRANK ANTHONY RUNCO
Title or Position: PRESIDENT
Credential: DMD
Phone: 314-352-4680