Healthcare Provider Details

I. General information

NPI: 1902916844
Provider Name (Legal Business Name): PHILIP JOSEPH RENDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7198 CHAPMAN DR SUITE 7
HAYES VA
23072-3416
US

IV. Provider business mailing address

125 LAYDON WAY
POQUOSON VA
23662-2243
US

V. Phone/Fax

Practice location:
  • Phone: 804-684-9971
  • Fax: 804-642-2097
Mailing address:
  • Phone: 757-868-7331
  • Fax: 804-642-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberVA0401008390
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: