Provider Demographics
NPI:1023287273
Name:RENZ, DAVID
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:RENZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 TARAVAL ST
Mailing Address - Street 2:102
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2218
Mailing Address - Country:US
Mailing Address - Phone:415-665-8397
Mailing Address - Fax:415-665-4532
Practice Address - Street 1:2033 TARAVAL ST
Practice Address - Street 2:102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2218
Practice Address - Country:US
Practice Address - Phone:415-665-8397
Practice Address - Fax:415-665-4532
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist