Provider Demographics
NPI:1538479449
Name:RODGERS BERBERENA, RENEE (RDH)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:RODGERS BERBERENA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3532
Mailing Address - Country:US
Mailing Address - Phone:360-848-7561
Mailing Address - Fax:360-925-3044
Practice Address - Street 1:5616 3RD AVE.
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-752-7410
Practice Address - Fax:360-383-0808
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH 00006089124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist