Provider Demographics
NPI:1104496462
Name:HAMILTON, RENAYE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:RENAYE
Middle Name:ELIZABETH
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7105
Mailing Address - Country:US
Mailing Address - Phone:575-337-4090
Mailing Address - Fax:
Practice Address - Street 1:1305 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7105
Practice Address - Country:US
Practice Address - Phone:575-337-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist