Provider Demographics
NPI:1114384393
Name:LAUREN YASUDA RAINEY, DDS, INC.
Entity Type:Organization
Organization Name:LAUREN YASUDA RAINEY, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:YASUDA
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-845-7003
Mailing Address - Street 1:2519 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2519 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2205
Practice Address - Country:US
Practice Address - Phone:510-845-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62337261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental