Provider Demographics
NPI:1407454523
Name:RENEW DENTAL P C
Entity Type:Organization
Organization Name:RENEW DENTAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-451-1500
Mailing Address - Street 1:1201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-4774
Mailing Address - Country:US
Mailing Address - Phone:978-451-1500
Mailing Address - Fax:978-451-1501
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4774
Practice Address - Country:US
Practice Address - Phone:978-451-1500
Practice Address - Fax:978-451-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty