MEDICARE: DR. CHRISTOPHER DOUGLAS RENEER 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	9098	CO
2	1223G0001X	General Practice Dentistry	D0623	SD

General Provider Information

NPI Number	:	1699856732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DOUGLAS RENEER D.D.S.

Provider Business Mailing Address
First Line	:	1555 W IRON SPRINGS RD STE 9
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1395
Country	:	US
Telephone Number	:	928-541-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 W IRON SPRINGS RD STE 9
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1395
Country	:	US
Telephone Number	:	928-541-7979
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	10/26/2015

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