| Renken Dentistry Pc | |
|
2801 Mansion Rd Springfield IL 62711-6724 | |
| (217) 483-7177 | |
| (217) 483-7190 |
| Full Name | Renken Dentistry Pc |
|---|---|
| Speciality | Dentist |
| Location | 2801 Mansion Rd, Springfield, Illinois |
| Authorized Official Name and Position | Joshua M Renken (OWNER) |
| Authorized Official Contact | 2174837177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renken Dentistry Pc 2801 Mansion Rd Springfield IL 62711-6724 Ph: (217) 483-7177 | Renken Dentistry Pc 2801 Mansion Rd Springfield IL 62711-6724 Ph: (217) 483-7177 |
| NPI Number | 1710162326 |
|---|---|
| Provider Enumeration Date | 01/02/2008 |
| Last Update Date | 08/28/2019 |
| Medicare PECOS PAC ID | 4486958667 |
|---|---|
| Medicare Enrollment ID | O20160209000636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710162326 | NPI | - | NPPES |
| 9183211 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019025823 (Illinois) | Primary |
| Provider Name | Joshua Matthew Renken |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467455378 PECOS PAC ID: 5395049571 Enrollment ID: I20160209000831 |
| Provider Name | Karen Zerkle |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1316233703 PECOS PAC ID: 2860710167 Enrollment ID: I20160209001032 |
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