Provider Demographics
NPI:1144606997
Name:RENTERIA, KLARISSA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KLARISSA
Middle Name:ANN
Last Name:RENTERIA
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:DAYDREAM FAMILY DENTISTRY
Mailing Address - Street 2:519 S. MISSOURI AVE
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-968-6561
Mailing Address - Fax:
Practice Address - Street 1:519 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6019
Practice Address - Country:US
Practice Address - Phone:956-968-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice