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General NPI Number Information
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NPI Number | 1679602312
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Entity Type | Individual
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Provider Name | MARK EDWARD RUNGE DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 518 HILLGROVE AVENUE SUITE 100
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1480
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Country | US
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Telephone | 708-246-8881
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Fax | 708-246-6858
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Provider Business Mailing Address
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Address Line | 518 HILLGROVE AVENUE SUITE 100
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1480
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Country | US
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Telephone | 708-246-8881
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Fax | 708-246-6858
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021001388
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019017664
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License Number State | IL
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