Basic Information
| Provider Information | |||||||||
| NPI: | 1518053370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENNER | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 OAK AVE | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939275648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316745344 | ||||||||
| FaxNumber: | 8316745214 | ||||||||
| Practice Location | |||||||||
| Address1: | 163 FORT EVANS RD NE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034432000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 54366 | CA | N | Dental Providers | Dentist | 122300000X | 0401415382 | VA | Y | Dental Providers | Dentist |
No ID Information.