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General NPI Number Information
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NPI Number | 1649530726
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Entity Type | Organization
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Legal Business Name | J TIM RAINEY, DDS, P.C.
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 606 OSAGE ST
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City | REFUGIO
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State | TX
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Zip | 78377-3229
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Country | US
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Telephone | 361-526-4695
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Fax | 361-526-4697
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Provider Business Mailing Address
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Address Line | PO BOX 1044
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City | REFUGIO
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State | TX
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Zip | 78377-1044
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Country | US
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Telephone | 361-526-4695
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Fax | 361-526-4697
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Authorized Official
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Title or Position | OWNER
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Name | DR. J TIM RAINEY
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Credential | DDS
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Telephone | 361-526-4695
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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 | 9536
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License Number State | TX
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