Provider Demographics
NPI:1245252287
Name:RENEW DENTAL PLLC
Entity type:Organization
Organization Name:RENEW DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:BENTING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:602-277-9088
Mailing Address - Street 1:301 E BETHANY HOME RD STE C194
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1266
Mailing Address - Country:US
Mailing Address - Phone:602-277-9088
Mailing Address - Fax:602-277-8889
Practice Address - Street 1:301 E BETHANY HOME RD STE C194
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1266
Practice Address - Country:US
Practice Address - Phone:602-277-9088
Practice Address - Fax:602-277-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ067551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty