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General NPI Number Information
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NPI Number | 1821403403
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Entity Type | Individual
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Provider Name | RUPESHWAR ISHWAR RENKUNTLA
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Gender | Male
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 240 S SAGINAW BLVD STE 200
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City | SAGINAW
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State | TX
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Zip | 76179-1672
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Country | US
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Telephone | 817-989-2832
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Fax | 817-989-2813
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Provider Business Mailing Address
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Address Line | 4108 LASSEN LN
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City | IRVING
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State | TX
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Zip | 75063-1248
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Country | US
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Telephone | 405-881-4752
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6605
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31354
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License Number State | TX
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