Provider Demographics
NPI:1649558784
Name:JAMES RENDA DMD
Entity Type:Organization
Organization Name:JAMES RENDA DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:RENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:504-392-4384
Mailing Address - Street 1:400 LAPALCO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7372
Mailing Address - Country:US
Mailing Address - Phone:504-392-4384
Mailing Address - Fax:
Practice Address - Street 1:400 LAPALCO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7372
Practice Address - Country:US
Practice Address - Phone:504-392-4384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6010261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental