Healthcare Provider Details

I. General information

NPI: 1174182018
Provider Name (Legal Business Name): PAUL RAINES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14025 E EXPOSITION AVE
AURORA CO
80012-2522
US

IV. Provider business mailing address

6438 S GLENCOE CT
CENTENNIAL CO
80121-3538
US

V. Phone/Fax

Practice location:
  • Phone: 303-340-0422
  • Fax:
Mailing address:
  • Phone: 907-244-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00204015
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: