Provider Demographics
NPI:1740697184
Name:MICHELE RENNARD DDS, PLLC
Entity type:Organization
Organization Name:MICHELE RENNARD DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-282-9988
Mailing Address - Street 1:157 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3045
Mailing Address - Country:US
Mailing Address - Phone:516-770-7345
Mailing Address - Fax:516-358-4394
Practice Address - Street 1:157 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3045
Practice Address - Country:US
Practice Address - Phone:516-770-7345
Practice Address - Fax:516-358-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty