Provider Demographics
NPI:1205676566
Name:RENDA, DAVIN VINCENZO (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVIN
Middle Name:VINCENZO
Last Name:RENDA
Suffix:
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 1:8891 KINGSPORT RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6167
Mailing Address - Country:US
Mailing Address - Phone:269-547-7594
Mailing Address - Fax:
Practice Address - Street 1:2131 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2302
Practice Address - Country:US
Practice Address - Phone:269-344-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist