Healthcare Provider Details

I. General information

NPI: 1366549552
Provider Name (Legal Business Name): RENEE BEATRICE DITO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 NEW BERN AVENUE NEW BERN RIDGE DENTAL CENTER
RALEIGH NC
27610
US

IV. Provider business mailing address

103 RIVER CREEK PLACE
CARRBORO NC
27510
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-2930
  • Fax: 919-231-8077
Mailing address:
  • Phone: 919-932-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4536
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: