=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497864078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RASHONDIA WILLIAMS GAINES D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 S UNIVERSITY DR
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-262-7338
-----------------------------------------------------
Fax | 954-262-7355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 424 MULBERRY GROVE RD
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-4531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-333-0069
-----------------------------------------------------
Fax | 561-753-6225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | TPNU043
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------