Healthcare Provider Details

I. General information

NPI: 1699443432
Provider Name (Legal Business Name): CATHERINE BERARD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 MCMILLEN CT
GREAT FALLS VA
22066-1602
US

IV. Provider business mailing address

908 MCMILLEN CT
GREAT FALLS VA
22066-1602
US

V. Phone/Fax

Practice location:
  • Phone: 703-901-6983
  • Fax:
Mailing address:
  • Phone: 703-901-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402002592
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: