Provider Demographics
NPI:1578302139
Name:RUNYON, CARRIE ANN (DDS)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:RUNYON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11706 RUSH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038
Mailing Address - Country:US
Mailing Address - Phone:812-698-3265
Mailing Address - Fax:
Practice Address - Street 1:17746 SUN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074
Practice Address - Country:US
Practice Address - Phone:317-896-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014444A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist