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General NPI Number Information
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NPI Number | 1407145204
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Entity Type | Organization
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Legal Business Name | RENAISSANCE DENTAL GROUP, LLC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 11 SOUTH ROAD SUITE 210
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City | FARMINGTON
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State | CT
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Zip | 06032
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Country | US
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Telephone | 860-321-7715
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Fax | 860-321-7617
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Provider Business Mailing Address
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Address Line | 11 SOUTH ROAD SUITE 210
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City | FARMINGTON
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State | CT
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Zip | 06032
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Country | US
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Telephone | 860-321-7715
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Fax | 860-321-7617
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RUEY-JANE TSAI
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Credential | D.M.D.
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Telephone | 860-321-7715
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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 | 9173
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8050
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License Number State | CT
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