Basic Information
| Provider Information | |||||||||
| NPI: | 1366549552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DITO | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | BEATRICE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 RIVER CREEK PLACE | ||||||||
| Address2: | |||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199329561 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2628 NEW BERN AVENUE | ||||||||
| Address2: | NEW BERN RIDGE DENTAL CENTER | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192502930 | ||||||||
| FaxNumber: | 9192318077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 4536 | NC | Y | Dental Providers | Dental Hygienist |
No ID Information.