Healthcare Provider Details

I. General information

NPI: 1982069290
Provider Name (Legal Business Name): LANDON JAY RENCHER, D.D.S., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34705 N NEWPORT HWY STE B
CHATTAROY WA
99003-7811
US

IV. Provider business mailing address

34705 N NEWPORT HWY STE B
CHATTAROY WA
99003-7811
US

V. Phone/Fax

Practice location:
  • Phone: 509-292-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LANDON J RENCHER
Title or Position: DENTIST
Credential: DDS
Phone: 801-859-2569