Active NPI
Frank Anthony Runco, DMD
- General Practice Dentistry
- Saint Louis, MO
National Provider Identifier
1366713596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14387
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160425002316 | MO | Order and Referring Only - Dentist | 8426357492 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14387 | MO | MD | General 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.