Provider Demographics
NPI:1497882336
Name:LOREN DALE RENCH JR. DDS INC
Entity Type:Organization
Organization Name:LOREN DALE RENCH JR. DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RENCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-494-3477
Mailing Address - Street 1:1650 XIMENO AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2150
Mailing Address - Country:US
Mailing Address - Phone:562-494-3477
Mailing Address - Fax:562-986-0043
Practice Address - Street 1:1650 XIMENO AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2150
Practice Address - Country:US
Practice Address - Phone:562-494-3477
Practice Address - Fax:562-986-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty