Provider Demographics
NPI:1477719078
Name:RENNAKER, THOMAS PERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PERRY
Last Name:RENNAKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12525 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2305
Mailing Address - Country:US
Mailing Address - Phone:760-208-3141
Mailing Address - Fax:818-760-2786
Practice Address - Street 1:12525 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91316-2305
Practice Address - Country:US
Practice Address - Phone:818-760-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice