Basic Information
| Provider Information | |||||||||
| NPI: | 1922343268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENIER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KATHRYN FOSSUM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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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 | 1223G0001X | D13064 | MN | Y | Dental Providers | Dentist | General Practice |
No ID Information.