Provider Demographics
NPI:1932493640
Name:YORK DENTAL GROUP, PA
Entity Type:Organization
Organization Name:YORK DENTAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-684-2366
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-0712
Mailing Address - Country:US
Mailing Address - Phone:803-684-2366
Mailing Address - Fax:803-684-9101
Practice Address - Street 1:333 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1575
Practice Address - Country:US
Practice Address - Phone:803-684-2366
Practice Address - Fax:803-684-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4294122300000X
SC2362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty