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General NPI Number Information
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NPI Number | 1922527787
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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 | 11/27/2019
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Provider Practice Location Address
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Address Line | 1825 CRYSTAL FALLS PKWY STE 130
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City | LEANDER
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State | TX
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Zip | 78641-3330
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Country | US
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Telephone | 512-337-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 CRYSTAL FALLS PARKWAY SUITE 130
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City | LEANDER
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State | TX
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Zip | 78641
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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 | AUTHORIZED OFFICIAL
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Name | JOSHUA RENKEN
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Credential | DDS
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Telephone | 217-483-7177
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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