Provider Demographics
NPI:1861416109
Name:RENNA, THOMAS RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:RENNA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2758
Mailing Address - Country:US
Mailing Address - Phone:973-627-7001
Mailing Address - Fax:973-983-8455
Practice Address - Street 1:4 2ND AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2758
Practice Address - Country:US
Practice Address - Phone:973-627-7001
Practice Address - Fax:973-983-8455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011326001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice