Provider Demographics
NPI:1174702765
Name:RENE, JEANINE (DENTAL HYGIENIST RDH)
Entity type:Individual
Prefix:MISS
First Name:JEANINE
Middle Name:
Last Name:RENE
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST RDH
Other - Prefix:MISS
Other - First Name:JEANINE
Other - Middle Name:
Other - Last Name:RENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENTAL HYGIENIST
Mailing Address - Street 1:47 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1116
Mailing Address - Country:US
Mailing Address - Phone:617-449-8610
Mailing Address - Fax:
Practice Address - Street 1:1425 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2253
Practice Address - Country:US
Practice Address - Phone:617-296-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13617124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist