Provider Demographics
NPI:1548430101
Name:RICHARD C. RENDER, D.D.S., P.A.
Entity Type:Organization
Organization Name:RICHARD C. RENDER, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-884-7706
Mailing Address - Street 1:8900 PENN AVE S
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2068
Mailing Address - Country:US
Mailing Address - Phone:952-884-7706
Mailing Address - Fax:952-881-6006
Practice Address - Street 1:8900 PENN AVE S
Practice Address - Street 2:SUITE 307
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2068
Practice Address - Country:US
Practice Address - Phone:952-884-7706
Practice Address - Fax:952-881-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty