Provider Demographics
NPI:1740065135
Name:PARR, RENEE (RDH BS MFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PARR
Suffix:
Gender:F
Credentials:RDH BS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DAWNWOOD
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0302
Mailing Address - Country:US
Mailing Address - Phone:949-306-5187
Mailing Address - Fax:
Practice Address - Street 1:5 DAWNWOOD
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0302
Practice Address - Country:US
Practice Address - Phone:949-306-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA16973124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No174400000XOther Service ProvidersSpecialist