| Organization Name: | RENEW ORTHODONTICS |
| NPI Number: | 1003049537 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARYL ASHBECK (ORTHODONTIST) |
| Mailing Address: | 2302 N Richmond Rd Mchenry |
| State: | IL US |
| Postal Code: | 600515403 |
| Phone Number: | 8153638474 |
| Fax Number: | 8153630246 |
| NPI Enumeration Date: | 09/01/2009 |
| NPI Last Update Date: | 09/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 019024635 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |