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General NPI Number Information
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NPI Number | 1558451898
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Entity Type | Organization
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Legal Business Name | DAVID P. RENAUD D.D.,P.C.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25520 LITTLE MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3371
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Country | US
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Telephone | 586-771-5888
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Fax | 586-777-7319
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Provider Business Mailing Address
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Address Line | 25520 LITTLE MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3371
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Country | US
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Telephone | 586-771-5888
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Fax | 586-777-7319
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID P. RENAUD
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Credential | DDS
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Telephone | 586-771-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | MI
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