Basic Information
| Provider Information | |||||||||
| NPI: | 1295269835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERBER | ||||||||
| FirstName: | DIJANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDH, BSDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 924 POCAHONTAS CT | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234305806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042740579 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6677 RICHMOND HWY | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223066647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355568 | ||||||||
| FaxNumber: | 7032243629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2017 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 0402205307 | VA | Y | Dental Providers | Dental Hygienist |
No ID Information.