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General NPI Number Information
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NPI Number | 1306362389
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Entity Type | Individual
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Provider Name | CRAIGORY JAMES RAINO DMD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2901 PLAINFIELD RD STE A
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City | JOLIET
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State | IL
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Zip | 60435-1129
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Country | US
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Telephone | 815-260-4396
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Fax |
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Provider Business Mailing Address
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Address Line | 15012 S CENTER ST
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City | PLAINFIELD
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State | IL
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Zip | 60544-1960
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Country | US
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Telephone | 815-260-4396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.031355
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License Number State | IL
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