=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861668055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J TIM RAINEY, II, D.D.S., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2008
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 E BLANCO RD SUITE 16
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-249-9300
-----------------------------------------------------
Fax | 830-249-9330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 E BLANCO RD SUITE 16
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-249-9300
-----------------------------------------------------
Fax | 830-249-9330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. J TIM RAINEY II
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 830-249-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------