# RENAISSANCE DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205030277
- **Authorized official:** DR. WALLACE L WALKER JR. DDS (DENTIST)
- **Authorized official phone:** (313) 340-9293

## Contact information

- **Practice address:** 7330 W WARREN AVE, DETROIT, MI 48210-1041
- **Practice address phone:** (313) 340-9293
- **Practice address fax:** (313) 340-9293
- **Mailing address:** 7330 W WARREN AVE, DETROIT, MI 48210-1041
- **Mailing address phone:** (313) 340-9293
- **Mailing address fax:** (313) 340-9293

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12881 | MI | Yes |

## Other

- **Enumeration date:** 06/13/2007
- **Last updated:** 08/22/2020