MEDICARE: JOHN P RENDE DDS SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2943-015	WI

General Provider Information

NPI Number	:	1417065970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN P RENDE DDS SC

Provider Business Mailing Address
First Line	:	1313-80TH STREET
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-5900
Country	:	US
Telephone Number	:	262-657-1980
Fax Number	:	262-657-5277

Provider Business Practice Location Address
First Line	:	1313-80TH STREET
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-5900
Country	:	US
Telephone Number	:	262-657-1980
Fax Number	:	262-657-5277

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN P RENDE
Credential	:	DDS
Telephone Number	:	262-657-1980

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	08/22/2020

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