Mark A Runyan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2262 Issued in ND

Practice address

100 4TH St S Ste 312
Fargo, ND 58103-1937

Phone

(701) 232-2409

Fax

(701) 232-2563

NPI assigned

Jun 9, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northcreek Dental PC

  • Endodontics
  • Fargo, ND
  • NPI 1467524496
  NPD (past)

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433808000000",
    "number": "1669853263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 4TH ST S STE 312",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031937",
            "telephone_number": "701-232-2409",
            "fax_number": "701-232-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 4TH ST S STE 312",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031937",
            "telephone_number": "701-232-2409",
            "fax_number": "701-232-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNYAN",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-09",
        "last_updated": "2015-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "2262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas L Rumpza, LAC
• Amy Runcorn, LPC
• Ariel Marie Running Bear, RN
• Courtney Runningen, PHARMD
• Cydney Judith Runsvold, RPH
• Ashley Marie Rupp
• Laura Rupp, DNP, APRN, FNP-C
• Howard L Russell, MD
• Mary Monica Russell, LRD, CDE
• Tanya Russiff, MSN, RN

• General Practice Dentistry in Fargo, ND
• Providers in Fargo, ND by specialty
• General Practice Dentistry in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; 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.

Verify at the official NPI Registry.