Provider Demographics
NPI:1831687094
Name:BOYLE, RENEE MARIE (RDH)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARIE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL HEALTH ACTVITY 351 W.6TH STREET
Mailing Address - Street 2:BLDG 440
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:571-801-6831
Mailing Address - Fax:
Practice Address - Street 1:DESMOND DOSS DENTAL CLINIC BUILDING 674, LETTER O
Practice Address - Street 2:BRANNON ROAD
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH012410124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist