Provider Demographics
NPI:1376064402
Name:RENNEGARBE, SHAINA BLAIR (DMD)
Entity Type:Individual
Prefix:MS
First Name:SHAINA
Middle Name:BLAIR
Last Name:RENNEGARBE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BENNORA LEE CT
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6281
Mailing Address - Country:US
Mailing Address - Phone:618-363-3300
Mailing Address - Fax:
Practice Address - Street 1:1637 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2853
Practice Address - Country:US
Practice Address - Phone:608-781-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001608-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist