Provider Demographics
NPI:1407078363
Name:JOSEPH RENZI, JR., D.D.S., INC.
Entity Type:Organization
Organization Name:JOSEPH RENZI, JR., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-972-1359
Mailing Address - Street 1:999 N TUSTIN AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:999 N TUSTIN AVE STE 219
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6506
Practice Address - Country:US
Practice Address - Phone:714-972-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD29430261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental