Provider Demographics
NPI:1831194141
Name:RENNELL, EDWIN J, JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:J, JR
Last Name:RENNELL
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:34441 8 MILE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4013
Mailing Address - Country:US
Mailing Address - Phone:248-471-5838
Mailing Address - Fax:248-474-4603
Practice Address - Street 1:34441 8 MILE RD
Practice Address - Street 2:STE 107
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:248-471-5838
Practice Address - Fax:248-474-4603
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI29010079131223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology