Provider Demographics
NPI:1558451898
Name:DAVID P. RENAUD D.D.,P.C.
Entity Type:Organization
Organization Name:DAVID P. RENAUD D.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:RENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-771-5888
Mailing Address - Street 1:25520 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3371
Mailing Address - Country:US
Mailing Address - Phone:586-771-5888
Mailing Address - Fax:586-777-7319
Practice Address - Street 1:25520 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3371
Practice Address - Country:US
Practice Address - Phone:586-771-5888
Practice Address - Fax:586-777-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty