Provider Demographics
NPI:1538123229
Name:HOMICK, RENEE J (RD H)
Entity type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:J
Last Name:HOMICK
Suffix:
Gender:F
Credentials:RD H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 MAIN ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-415-4297
Mailing Address - Fax:
Practice Address - Street 1:190 CORAM AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-924-4115
Practice Address - Fax:203-924-1301
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005988124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist