Provider Demographics
NPI:1225032550
Name:RENDE, JOHN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:RENDE
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 1:1313 - 80 STREET
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5900
Mailing Address - Country:US
Mailing Address - Phone:262-657-1980
Mailing Address - Fax:262-657-5277
Practice Address - Street 1:1313 - 80 STREET
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5900
Practice Address - Country:US
Practice Address - Phone:262-657-1980
Practice Address - Fax:262-657-5277
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2943-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice