=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174182018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL RAINES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2019
-----------------------------------------------------
Last Update Date | 06/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14025 E EXPOSITION AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80012-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-340-0422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6438 S GLENCOE CT
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80121-3538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-244-7145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 00204015
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------