Provider Demographics
NPI:1669541033
Name:FOURNIER, RENE (DMD)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1535
Mailing Address - Country:US
Mailing Address - Phone:210-928-2814
Mailing Address - Fax:210-927-4276
Practice Address - Street 1:6500 NORTH FREEWAY #124
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076
Practice Address - Country:US
Practice Address - Phone:713-696-8111
Practice Address - Fax:713-696-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice