Provider Demographics
NPI:1477661353
Name:MAYNES & RENGER DENTISTRY
Entity Type:Organization
Organization Name:MAYNES & RENGER DENTISTRY
Other - Org Name:DRESHER FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:XIN
Authorized Official - Middle Name:MU
Authorized Official - Last Name:RENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-643-4740
Mailing Address - Street 1:1615 LIMEKILN PIKE
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1007
Mailing Address - Country:US
Mailing Address - Phone:215-643-4740
Mailing Address - Fax:215-643-9131
Practice Address - Street 1:1615 LIMEKILN PIKE
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1007
Practice Address - Country:US
Practice Address - Phone:215-643-4740
Practice Address - Fax:215-643-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA035076261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental