Provider Demographics
NPI:1013235522
Name:RENCK, ROBERT PAUL II (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:RENCK
Suffix:II
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 1:1818 W FRANCIS AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6834
Mailing Address - Country:US
Mailing Address - Phone:828-318-2196
Mailing Address - Fax:
Practice Address - Street 1:707 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:828-318-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149031223G0001X
WA608905871223G0001X
CA588261223G0001X
CO99881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice