Healthcare Provider Details

I. General information

NPI: 1811060106
Provider Name (Legal Business Name): JOHN E RAINVILLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEBORRAH J NORDBLOM D.D.S.

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 1ST AVE SW
ROCHESTER MN
55902-3144
US

IV. Provider business mailing address

212 1ST AVE SW
ROCHESTER MN
55902-3144
US

V. Phone/Fax

Practice location:
  • Phone: 507-285-1121
  • Fax: 507-285-5384
Mailing address:
  • Phone: 507-285-1121
  • Fax: 507-285-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10159
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10101
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5638
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: