Provider Demographics
NPI:1326300450
Name:RENDER, PHILIP (DMD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:RENDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 E HIGHWAY 501
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9521
Mailing Address - Country:US
Mailing Address - Phone:843-477-2171
Mailing Address - Fax:843-477-2172
Practice Address - Street 1:3500 PAMPAS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5168
Practice Address - Country:US
Practice Address - Phone:843-477-2171
Practice Address - Fax:843-477-2172
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-2437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist