MEDICARE: CALEB RAINEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.027181	OH

General Provider Information

NPI Number	:	1619669579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB RAINEY

Provider Business Mailing Address
First Line	:	1690 W LANE AVE UNIT 346
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3967
Country	:	US
Telephone Number	:	734-239-2849
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 WALNUT CREEK PIKE
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1048
Country	:	US
Telephone Number	:	740-477-2220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “ CALEB RAINEY ” Practice Location

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