Provider Demographics
NPI:1710502901
Name:RENEW FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:RENEW FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PROBST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:262-339-8450
Mailing Address - Street 1:5575 WARREN PKWY STE 324
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4095
Mailing Address - Country:US
Mailing Address - Phone:262-339-8450
Mailing Address - Fax:
Practice Address - Street 1:5575 WARREN PKWY STE 324
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4095
Practice Address - Country:US
Practice Address - Phone:262-339-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental