Provider Demographics
NPI:1811062904
Name:RENZ, GENE S (DDS)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:S
Last Name:RENZ
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 1:101 WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379
Mailing Address - Country:US
Mailing Address - Phone:860-599-1530
Mailing Address - Fax:860-599-0326
Practice Address - Street 1:101 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379
Practice Address - Country:US
Practice Address - Phone:860-599-1530
Practice Address - Fax:860-599-0326
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist