Individual
RAHUL RENJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
103 WHITE PARK RD, ITHACA, NY 14850-2258
(716) 523-1885
Mailing address
2124 PENFIELD RD, PENFIELD, NY 14526-1736
(585) 432-0455
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
051708-1
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DS037113
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02898355
—
NY
05
—
1020266440001
—
PA
Enumeration date
03/16/2007
Last updated
04/14/2015
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