MEDICARE: JENNA N RENSHAW D.D.S.

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	31803	TX
2	122300000X	Dentist	30-023660	OH

General Provider Information

NPI Number	:	1568757656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA N RENSHAW D.D.S.

Provider Business Mailing Address
First Line	:	7859 WALNUT HILL LN STE 205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7859 WALNUT HILL LN STE 205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5605
Country	:	US
Telephone Number	:	307-760-0290
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	03/17/2018

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