Provider Demographics
NPI:1790964286
Name:DR PHILIP J RENDER DMD
Entity Type:Organization
Organization Name:DR PHILIP J RENDER DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-684-9971
Mailing Address - Street 1:7198 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072
Mailing Address - Country:US
Mailing Address - Phone:804-684-9971
Mailing Address - Fax:804-642-2097
Practice Address - Street 1:7198 CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3416
Practice Address - Country:US
Practice Address - Phone:804-684-9971
Practice Address - Fax:804-642-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010083901223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty