Healthcare Provider Details

I. General information

NPI: 1013823558
Provider Name (Legal Business Name): RUSSEL B. RAINEY, D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 7TH AVE
TALLAHASSEE FL
32303-5518
US

IV. Provider business mailing address

221 E 7TH AVE
TALLAHASSEE FL
32303-5518
US

V. Phone/Fax

Practice location:
  • Phone: 850-385-3700
  • Fax:
Mailing address:
  • Phone: 850-385-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY DUPIN
Title or Position: MANAGER OF CREDENTIALING
Credential:
Phone: 480-674-4151