=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891045266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BILLIE EILEEN VONENGELN RDH, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2012
-----------------------------------------------------
Last Update Date | 10/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ANDREW RADER DENTAL CLINIC 401 CARPENTER RD. BLDG. 525
-----------------------------------------------------
City | FT. MYER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-696-3460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ANDREW RADER DENTAL CLINIC 401 CARPENTER RD. BLDG. 525
-----------------------------------------------------
City | FT. MYER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-696-3460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 903185
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 101139
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 0402207780
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------