Provider Demographics
NPI:1740235514
Name:RENS, CHRISTINA H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:H
Last Name:RENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BIRCH ST
Mailing Address - Street 2:PO BOX 147
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-9439
Mailing Address - Country:US
Mailing Address - Phone:715-223-4844
Mailing Address - Fax:
Practice Address - Street 1:202 BIRCH ST
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-9439
Practice Address - Country:US
Practice Address - Phone:715-223-4844
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI4940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33742700Medicaid