Individual provider Active NPI

Frank Anthony Runco, DMD

  • General Practice Dentistry
  • Saint Louis, MO
National Provider Identifier
1366713596
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14387 Issued in MO
Practice address
64 Crestwood Executive Ctr
Saint Louis, MO 63126-1904
Phone
(314) 843-0470
Fax
(314) 843-0438
NPI assigned
Jan 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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 14387 MO Primary

Addresses

Primary practice location

64 Crestwood Executive Ctr
Saint Louis, MO 63126-1904

Mailing address

64 Crestwood Executive Ctr
Saint Louis, MO 63126-1904
Phone (314) 843-0470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20160425002316 MO Order and Referring Only - DentistPractitioner - Dentist 8426357492

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14387MOMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1366713596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 CRESTWOOD EXECUTIVE CTR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631261904",
            "telephone_number": "314-843-0470",
            "fax_number": "314-843-0438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 CRESTWOOD EXECUTIVE CTR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631261904",
            "telephone_number": "314-843-0470",
            "fax_number": "314-843-0438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNCO",
        "first_name": "FRANK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-19",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "14387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.