Provider Demographics
NPI:1902916844
Name:RENDER, PHILIP JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:RENDER
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 1:125 LAYDON WAY
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-2243
Mailing Address - Country:US
Mailing Address - Phone:757-868-7331
Mailing Address - Fax:804-642-2097
Practice Address - Street 1:7198 CHAPMAN DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3416
Practice Address - Country:US
Practice Address - Phone:804-684-9971
Practice Address - Fax:804-642-2097
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA04010083901223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8390OtherDELTA PROVIDER
VA970780OtherUNITED CONCORDIA PROVIDER
VAVA0401008390OtherSTATE OF VA LICENSE #
VA106648Medicaid
VA106648Medicaid