Provider Demographics
NPI:1154872646
Name:RENAISSANCE DENTISTRY
Entity type:Organization
Organization Name:RENAISSANCE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RYLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-363-8444
Mailing Address - Street 1:800 W WILLIAMS STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502
Mailing Address - Country:US
Mailing Address - Phone:919-323-8444
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502
Practice Address - Country:US
Practice Address - Phone:919-323-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty