Provider Demographics
NPI:1124374848
Name:RENNARD-SCARANTINO, MICHELE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANN
Last Name:RENNARD-SCARANTINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:RENNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:157 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3045
Mailing Address - Country:US
Mailing Address - Phone:516-282-9988
Mailing Address - Fax:516-358-4394
Practice Address - Street 1:157 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3045
Practice Address - Country:US
Practice Address - Phone:516-282-9988
Practice Address - Fax:516-358-4394
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0486261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice