Provider Demographics
NPI:1508411844
Name:RENAS, STEVEN CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:RENAS
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 1:2502 THOMAS AVE APT 121
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2077
Mailing Address - Country:US
Mailing Address - Phone:630-624-1265
Mailing Address - Fax:
Practice Address - Street 1:1930 E ROSEMEADE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2467
Practice Address - Country:US
Practice Address - Phone:972-492-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice