1366549552 NPI number — MRS. RENEE BEATRICE DITO RDH

Table of content: MRS. RENEE BEATRICE DITO RDH (NPI 1366549552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366549552 NPI number — MRS. RENEE BEATRICE DITO RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DITO
Provider First Name:
RENEE
Provider Middle Name:
BEATRICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366549552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 RIVER CREEK PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARRBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-932-9561
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2628 NEW BERN AVENUE
Provider Second Line Business Practice Location Address:
NEW BERN RIDGE DENTAL CENTER
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-250-2930
Provider Business Practice Location Address Fax Number:
919-231-8077
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  4536 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com