Provider Demographics
NPI:1295269835
Name:BERBER, DIJANA (RDH, BSDH)
Entity type:Individual
Prefix:
First Name:DIJANA
Middle Name:
Last Name:BERBER
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 POCAHONTAS CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-5806
Mailing Address - Country:US
Mailing Address - Phone:804-274-0579
Mailing Address - Fax:
Practice Address - Street 1:6677 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-6647
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:703-224-3629
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205307124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist