Provider Demographics
NPI:1316389794
Name:RENZ, BRIELLE MARY (DMD)
Entity type:Individual
Prefix:MRS
First Name:BRIELLE
Middle Name:MARY
Last Name:RENZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 E CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5616
Mailing Address - Country:US
Mailing Address - Phone:701-255-4850
Mailing Address - Fax:701-255-4852
Practice Address - Street 1:1839 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5616
Practice Address - Country:US
Practice Address - Phone:701-255-4850
Practice Address - Fax:701-255-4852
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice