Provider Demographics
NPI:1124196993
Name:STEPHEN LEE RENNER D.D.S. P.A.
Entity Type:Organization
Organization Name:STEPHEN LEE RENNER D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-876-3196
Mailing Address - Street 1:4936 WINDY HILL DR
Mailing Address - Street 2:A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4930
Mailing Address - Country:US
Mailing Address - Phone:919-876-3196
Mailing Address - Fax:
Practice Address - Street 1:4936 WINDY HILL DR
Practice Address - Street 2:A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4930
Practice Address - Country:US
Practice Address - Phone:919-876-3196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty