Provider Demographics
NPI:1609119965
Name:RENEWAL DENTAL PC
Entity Type:Organization
Organization Name:RENEWAL DENTAL PC
Other - Org Name:PEAK DENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-878-8844
Mailing Address - Street 1:74 GRAY RD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2062
Mailing Address - Country:US
Mailing Address - Phone:207-878-8844
Mailing Address - Fax:207-878-8847
Practice Address - Street 1:74 GRAY RD
Practice Address - Street 2:UNIT 3
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2062
Practice Address - Country:US
Practice Address - Phone:207-878-8844
Practice Address - Fax:207-878-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty