Healthcare Provider Details

I. General information

NPI: 1619345840
Provider Name (Legal Business Name): JOSHUA RENK DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S RAMPART BLVD STE 250
LAS VEGAS NV
89145-4888
US

IV. Provider business mailing address

851 S RAMPART BLVD STE 250
LAS VEGAS NV
89145-4888
US

V. Phone/Fax

Practice location:
  • Phone: 702-263-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number61138
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberS5-47C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: