Healthcare Provider Details

I. General information

NPI: 1750406237
Provider Name (Legal Business Name): JAMES ROBERT RENEAU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NW EXPRESSWAY ST SUITE 5
OKLAHOMA CITY OK
73112-7084
US

IV. Provider business mailing address

2751 NW EXPRESSWAY ST SUITE 5
OKLAHOMA CITY OK
73112-7084
US

V. Phone/Fax

Practice location:
  • Phone: 404-840-3363
  • Fax:
Mailing address:
  • Phone: 404-840-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3776
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: