Provider Demographics
NPI:1134278674
Name:RENNA, MARIANN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIANN
Middle Name:P
Last Name:RENNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 CROMPOND ROAD
Mailing Address - Street 2:C-1
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4141
Mailing Address - Country:US
Mailing Address - Phone:914-737-4002
Mailing Address - Fax:914-737-6198
Practice Address - Street 1:1879 CROMPOND RD
Practice Address - Street 2:C-1
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-4142
Practice Address - Country:US
Practice Address - Phone:914-737-4002
Practice Address - Fax:914-737-6198
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice