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General NPI Number Information
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NPI Number | 1841408994
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Entity Type | Individual
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Provider Name | CHRISTY C. DIRENZO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26777 LORAIN RD STE 300
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3225
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Country | US
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Telephone | 440-734-2171
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Fax | 440-734-2141
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Provider Business Mailing Address
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Address Line | 4435 W RANCHVIEW AVE
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-2755
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Country | US
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Telephone | 440-734-2811
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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 | 20702
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License Number State | OH
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