MEDICARE: JESSICA H. RENAKER, DMD PLLC

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
1	261QD0000X	Dental Clinic/Center	8890	KY

General Provider Information

NPI Number	:	1558891275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA H. RENAKER, DMD PLLC

Provider Business Mailing Address
First Line	:	730 N GREEN ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2951
Country	:	US
Telephone Number	:	270-791-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 N GREEN ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2951
Country	:	US
Telephone Number	:	270-826-7772
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JESSICA HANCOCK RENAKER
Credential	:	DMD
Telephone Number	:	270-791-7101

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	06/14/2017

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