Provider Demographics
NPI:1699856732
Name:RENEER, CHRISTOPHER DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DOUGLAS
Last Name:RENEER
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 1:1555 W IRON SPRINGS RD STE 9
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1395
Mailing Address - Country:US
Mailing Address - Phone:928-541-7979
Mailing Address - Fax:
Practice Address - Street 1:1555 W IRON SPRINGS RD STE 9
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1395
Practice Address - Country:US
Practice Address - Phone:928-541-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90981223G0001X
SDD06231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice