Healthcare Provider Details

I. General information

NPI: 1447986187
Provider Name (Legal Business Name): ROBERT G REDENZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 NE 8TH ST
BELLEVUE WA
98004-4345
US

IV. Provider business mailing address

519 COLUMBUS DR
SAVANNAH GA
31405-4306
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-1345
  • Fax:
Mailing address:
  • Phone: 804-955-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61529551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: