Bruce J Renn, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS0201156 Issued in PA

Practice address

202 Union St
Ste 3
Titusville, PA 16354

Phone

(814) 827-6714

Fax

(814) 827-2706

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194948943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 UNION ST",
            "address_2": "STE 3",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "16354",
            "telephone_number": "814-827-6714",
            "fax_number": "814-827-2706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 UNION ST",
            "address_2": "STE 3",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "16354",
            "telephone_number": "814-827-6714",
            "fax_number": "814-827-2706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENN",
        "first_name": "BRUCE",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS0201156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005205570001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cristian L Popescu, MD
• Primary Health Network
• Primary Health Network
• Shelly L Proper, LPC
• Raymond L. Tipton M D PC
• Rite Aid of Pennsylvania LLC
• Dwain M. Rogers, M.D.
• Lisa G Rubin, M.D.
• Theodore Larry Ryznar, R .PH.
• Saint Vincent Medical Education and Research Institute

• General Practice Dentistry in Titusville, PA
• Providers in Titusville, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.