Provider Demographics
NPI:1811720840
Name:DR. RENDON DENTAL SERVICES P C
Entity type:Organization
Organization Name:DR. RENDON DENTAL SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-925-4970
Mailing Address - Street 1:3354 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3317
Mailing Address - Country:US
Mailing Address - Phone:773-925-4970
Mailing Address - Fax:630-449-4713
Practice Address - Street 1:3354 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3317
Practice Address - Country:US
Practice Address - Phone:773-925-4970
Practice Address - Fax:630-449-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental