Provider Demographics
NPI:1104476704
Name:RENFROW, JOANDREA LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:JOANDREA
Middle Name:LEIGH
Last Name:RENFROW
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4623
Mailing Address - Country:US
Mailing Address - Phone:541-269-5353
Mailing Address - Fax:
Practice Address - Street 1:295 S 10TH ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4623
Practice Address - Country:US
Practice Address - Phone:541-269-5353
Practice Address - Fax:541-266-0933
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD111541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD11154OtherOREGON BOARD OF DENTISTRY