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General NPI Number Information
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NPI Number | 1891334058
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Entity Type | Individual
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Provider Name | DR. RENELLE CONNER
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Gender | Female
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Dates
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Enumeration Date | 01/04/2020
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 6525 BURDEN BLVD
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City | PASCO
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State | WA
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Zip | 99301-9822
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Country | US
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Telephone | 509-728-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 1780 FORT RD
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City | TOPPENISH
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State | WA
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Zip | 98948-9556
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Country | US
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Telephone | 907-854-8705
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11411
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 60763024
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License Number State | WA
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