Provider Demographics
NPI:1750627766
Name:REMBERT, ADRIENNE ROCHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:ROCHELLE
Last Name:REMBERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 MISSISSIPPI AVE, BLDG 1561
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY, ATTN: CREDENTIALS
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459
Mailing Address - Country:US
Mailing Address - Phone:601-259-2288
Mailing Address - Fax:
Practice Address - Street 1:7223 MISSISSIPPI AVE
Practice Address - Street 2:US ARMY DENTAL ACTIVITY, ATTN: CREDENTIALS
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014137771223G0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes1223G0001XDental ProvidersDentistGeneral Practice