Provider Demographics
NPI:1326517830
Name:DEWENTER, RENE (DDS)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:DEWENTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37512 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7726
Mailing Address - Country:US
Mailing Address - Phone:509-879-9104
Mailing Address - Fax:
Practice Address - Street 1:42505 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8835
Practice Address - Country:US
Practice Address - Phone:760-342-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11052110-99211223G0001X
WADE612856751223G0001X
CA1088361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicaid