Provider Demographics
NPI:1477287977
Name:RENFRO, MCKENNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MCKENNA
Middle Name:
Last Name:RENFRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 E RENEE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-3061
Mailing Address - Country:US
Mailing Address - Phone:602-475-4911
Mailing Address - Fax:
Practice Address - Street 1:25155 N 67TH AVE STE 142
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1065
Practice Address - Country:US
Practice Address - Phone:623-561-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0115041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice