Provider Demographics
NPI:1144603242
Name:RENZ, JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:RENZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14958 BONNER CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5512
Mailing Address - Country:US
Mailing Address - Phone:574-952-7324
Mailing Address - Fax:
Practice Address - Street 1:11559 CUMBERLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9784
Practice Address - Country:US
Practice Address - Phone:317-579-5400
Practice Address - Fax:317-579-5410
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012356A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist