Healthcare Provider Details

I. General information

NPI: 1669541033
Provider Name (Legal Business Name): RENE FOURNIER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 NORTH FREEWAY #124
HOUSTON TX
77076
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 713-696-8111
  • Fax: 713-696-8118
Mailing address:
  • Phone: 210-928-2814
  • Fax: 210-927-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2127
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: