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NPI Code Detail

MEDICARE: JOSHUA MATTHEW RENKEN DDS

MEDICARE:   JOSHUA MATTHEW RENKEN  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistIL

General Provider Information

NPI Number : 1467455378
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA MATTHEW RENKEN DDS
Provider Business Mailing Address
First Line : 901 MONARCH DR
Second Line :
City : CHATHAM
State : IL
Zip : 62629-9672
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7000 PIPER GLEN DR
Second Line : STE B
City : SPRINGFIELD
State : IL
Zip : 62711-7390
Country : US
Telephone Number : 217-483-7177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/08/2007

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Directions to “ JOSHUA MATTHEW RENKEN DDS” Practice Location

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