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General NPI Number Information
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NPI Number | 1487173266
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Entity Type | Organization
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Legal Business Name | RENKEN DENTISTRY OF TEXAS PLLC
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 5725 WILLIAMS DR STE 101
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City | GEORGETOWN
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State | TX
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Zip | 78633-2216
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Country | US
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Telephone | 512-667-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 5725 WILLIAMS DR SUITE 101
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City | GEORGETOWN
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State | TX
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Zip | 78633
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALICIA JONES
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Credential |
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Telephone | 512-667-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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