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General NPI Number Information
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NPI Number | 1003546334
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Entity Type | Individual
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Provider Name | DEMRA RENFRO DDS
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 9404 S ELWOOD AVE
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City | JENKS
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State | OK
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Zip | 74037-2317
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Country | US
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Telephone | 182-992-2989
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Fax |
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Provider Business Mailing Address
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Address Line | 3316 JONES LAKE RD
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-3760
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Country | US
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Telephone | 479-586-0146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12789
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License Number State | NC
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