Provider Demographics
NPI:1013225804
Name:RAINBOW SMILES DENTAL CENTER LLC
Entity Type:Organization
Organization Name:RAINBOW SMILES DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:FYFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDSQ
Authorized Official - Phone:903-938-5900
Mailing Address - Street 1:1800 BOMAR ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-6728
Mailing Address - Country:US
Mailing Address - Phone:903-938-5900
Mailing Address - Fax:903-938-5903
Practice Address - Street 1:1800 BOMAR ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-6728
Practice Address - Country:US
Practice Address - Phone:903-938-5900
Practice Address - Fax:903-938-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty