Provider Demographics
NPI:1710001540
Name:JOSKOW, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:JOSKOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83024
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20883-3024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND ST SW
Practice Address - Street 2:ROOM # B732
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0002
Practice Address - Country:US
Practice Address - Phone:202-372-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0400871223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health