NPIMap

Organization Active NPI

Renken Dentistry PC

  • General Practice Dentistry
  • Springfield, IL
National Provider Identifier
1710162326
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025823 Issued in IL
Legal business name
RENKEN DENTISTRY PC
Practice address
2801 Mansion Rd
Springfield, IL 62711-6724
Phone
(217) 483-7177
Fax
(217) 483-7190
NPI assigned
Jan 2, 2008
Last updated
Aug 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

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

Authorized official

Name
Dr. Joshua M Renken, D.D.S.NPI 1467455378
Title
Owner
Phone
(217) 483-7177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019025823 IL Primary

Addresses

Primary practice location

2801 Mansion Rd
Springfield, IL 62711-6724

Mailing address

2801 Mansion Rd
Springfield, IL 62711-6724
Phone (217) 483-7177

Other identifiers 1

IdentifierTypeStateIssuer
9183211MedicaidIL

National Provider Directory

National Provider Directory

Locations

2801 Mansion Rd
Springfield, IL 62711
Phone (217) 483-7177

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566950400000",
    "number": "1710162326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 MANSION RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116724",
            "telephone_number": "217-483-7177",
            "fax_number": "217-483-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 MANSION RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116724",
            "telephone_number": "217-483-7177",
            "fax_number": "217-483-7190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENKEN DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2019-08-28",
        "status": "A",
        "authorized_official_last_name": "RENKEN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-483-7177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9183211",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.