Individual provider Active NPI

Richard D Runkle Jr., DDS

  • General Practice Dentistry
  • Fayetteville, NC
National Provider Identifier
1124154281
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4397 Issued in NC
Practice address
2407 Robeson St
Fayetteville, NC 28305-5549
Phone
(910) 483-7853
NPI assigned
Feb 25, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4397 NC Primary

Addresses

Primary practice location

2407 Robeson St
Fayetteville, NC 28305-5549

Mailing address

2407 Robeson St
Fayetteville, NC 28305-5549
Phone (910) 483-7853

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160630000613 NC Order and Referring Only - DentistPractitioner - Dentist 5294027835

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124154281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 ROBESON ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055549",
            "telephone_number": "910-483-7853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 ROBESON ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055549",
            "telephone_number": "910-483-7853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNKLE",
        "first_name": "RICHARD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "4397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.