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General NPI Number Information
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NPI Number | 1861989394
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Entity Type | Organization
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Legal Business Name | RENA BAINS DDS INC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 2301 ST PAULS WAY
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City | MODESTO
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State | CA
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Zip | 95355-3309
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Country | US
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Telephone | 209-578-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 ST PAULS WAY
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City | MODESTO
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State | CA
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Zip | 95355-3309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RENA BAINS
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Credential |
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Telephone | 209-578-4153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 43683
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License Number State | CA
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