Provider Demographics
NPI:1891899365
Name:RENFROE, JONATHAN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:RENFROE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3901
Mailing Address - Country:US
Mailing Address - Phone:256-891-3439
Mailing Address - Fax:
Practice Address - Street 1:65 WALL ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7392
Practice Address - Country:US
Practice Address - Phone:256-878-0525
Practice Address - Fax:256-878-0521
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-92578OtherBC/BS OF AL