Provider Demographics
NPI:1831403856
Name:ALLSWANG, RENA (DDS)
Entity type:Individual
Prefix:DR
First Name:RENA
Middle Name:
Last Name:ALLSWANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25560 WOODVILLA PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2047
Mailing Address - Country:US
Mailing Address - Phone:347-665-3464
Mailing Address - Fax:347-665-3464
Practice Address - Street 1:20302 EUREKA RD
Practice Address - Street 2:SUITE A
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5310
Practice Address - Country:US
Practice Address - Phone:734-283-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist