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General NPI Number Information
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NPI Number | 1841633492
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Entity Type | Organization
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Legal Business Name | RAINBOW DENTAL CARE,PLLC
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Dates
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Enumeration Date | 04/14/2013
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Last Update Date | 04/14/2013
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Provider Practice Location Address
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Address Line | 490 IH 10 N SUITE 200
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City | BEAUMONT
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State | TX
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Zip | 77702-1822
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Country | US
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Telephone | 917-345-3916
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Fax |
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Provider Business Mailing Address
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Address Line | 490 IH 10 N SUITE 200
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City | BEAUMONT
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State | TX
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Zip | 77702-1822
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Country | US
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Telephone | 917-345-3916
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SWARNALATHA DEVI BATHINA
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Credential | DDS
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Telephone | 917-345-3916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 25683
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License Number State | TX
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