Provider Demographics
NPI:1265837108
Name:RAINES, JERRIE J (DDS)
Entity Type:Individual
Prefix:
First Name:JERRIE
Middle Name:J
Last Name:RAINES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 HIXSON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4466
Mailing Address - Country:US
Mailing Address - Phone:423-877-3848
Mailing Address - Fax:423-877-3726
Practice Address - Street 1:4845 HIXSON PIKE STE C
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4466
Practice Address - Country:US
Practice Address - Phone:423-877-3848
Practice Address - Fax:423-877-3726
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist