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General NPI Number Information
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NPI Number | 1396802740
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Entity Type | Individual
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Provider Name | KATHLEEN LOGAN RUNDQUIST DDS
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 W NICOLLET BLVD
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City | BURNSVILLE
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State | MN
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Zip | 55337-4524
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Country | US
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Telephone | 952-892-6010
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Fax | 952-891-0203
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Provider Business Mailing Address
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Address Line | 5032 MORGAN AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-1024
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Country | US
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Telephone | 612-925-3559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D10682
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License Number State | MN
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