Healthcare Provider Details

I. General information

NPI: 1346537354
Provider Name (Legal Business Name): LAUREN YASUDA RAINEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 05/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 ASHBY AVE
BERKELEY CA
94705-2205
US

IV. Provider business mailing address

2519 ASHBY AVENUE
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-7003
  • Fax: 510-845-7760
Mailing address:
  • Phone: 510-845-7003
  • Fax: 510-845-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDL11268
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: