Provider Demographics
NPI:1588836639
Name:ROLAND, RENEE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LYNN
Last Name:ROLAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 FIVE MILE LINE RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1450
Mailing Address - Country:US
Mailing Address - Phone:585-385-8700
Mailing Address - Fax:585-383-8588
Practice Address - Street 1:2088 FIVE MILE LINE RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1450
Practice Address - Country:US
Practice Address - Phone:585-385-8700
Practice Address - Fax:585-383-8588
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0549661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics