MEDICARE: YUXUAN REN DENTIST

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	122300000X	Dentist	8211	NV
2	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1447603204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUXUAN REN DENTIST

Provider Business Mailing Address
First Line	:	8025 BONAVENTURE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-5649
Country	:	US
Telephone Number	:	928-266-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 RANDOLPH RD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73503-4535
Country	:	US
Telephone Number	:	580-442-5925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	06/24/2026

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Directions to “ YUXUAN REN DENTIST” Practice Location

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