Provider Demographics
NPI:1346298635
Name:RAINS, GEORGE KENNETH JR (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:KENNETH
Last Name:RAINS
Suffix:JR
Gender:M
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:PO DRAWER C
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74362
Mailing Address - Country:US
Mailing Address - Phone:918-825-7411
Mailing Address - Fax:918-825-7734
Practice Address - Street 1:109 N FAIRLAND ST
Practice Address - Street 2:STE 110
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361
Practice Address - Country:US
Practice Address - Phone:918-825-7411
Practice Address - Fax:918-825-7734
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist