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General NPI Number Information
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NPI Number | 1326300450
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Entity Type | Individual
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Provider Name | PHILIP RENDER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 3500 PAMPAS DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5168
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Country | US
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Telephone | 843-477-2171
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Fax | 843-477-2172
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Provider Business Mailing Address
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Address Line | 2050 E HIGHWAY 501
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City | CONWAY
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State | SC
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Zip | 29526-9521
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Country | US
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Telephone | 843-477-2171
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Fax | 843-477-2172
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-2437
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License Number State | SC
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