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Organization
RENNIGADE DENTAL GROUP PLLC
Active
Organization
RENNIGADE DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVON RENNIE (OWNER)
(904) 495-0881
Entity
Organization
Contact information
Practice address
1747 US HIGHWAY 1 S, ST AUGUSTINE, FL 32084-4238
(904) 495-0881
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
06/15/2023
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