Provider Demographics
NPI:1619925039
Name:RENDER, RICHARD CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:RENDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 PENN AVE S
Mailing Address - Street 2:#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:#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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist