Individual
DR. GARY RENEGAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1831 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 521-6400
(479) 521-0164
Mailing address
1831 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 521-6400
(479) 521-0164
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1942
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58605
BLUE CROSS BLUE SHIELD
AR
Enumeration date
09/20/2006
Last updated
07/08/2007
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