Provider Demographics
NPI:1205969243
Name:RENIE, DONALD CHARLES (DMD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CHARLES
Last Name:RENIE
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 1:1900 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-882-2929
Mailing Address - Fax:541-850-0930
Practice Address - Street 1:1900 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-882-2929
Practice Address - Fax:541-850-0930
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD38951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice