Provider Demographics
NPI:1417062035
Name:RENFROE, DEREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:RENFROE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 MOORES LN
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8037
Mailing Address - Country:US
Mailing Address - Phone:615-942-7811
Mailing Address - Fax:615-942-7609
Practice Address - Street 1:8113 MOORES LN
Practice Address - Street 2:SUITE 2100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8037
Practice Address - Country:US
Practice Address - Phone:615-942-7811
Practice Address - Fax:615-942-7609
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8393122300000X
TN91141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist