Provider Demographics
NPI:1356455562
Name:RAINEY, VERNON LEE (DDS)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:LEE
Last Name:RAINEY
Suffix:
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 BOX 3296
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-3296
Mailing Address - Country:US
Mailing Address - Phone:757-934-0476
Mailing Address - Fax:757-539-1321
Practice Address - Street 1:426 WEST WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5363
Practice Address - Country:US
Practice Address - Phone:757-934-0476
Practice Address - Fax:757-539-1321
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010050221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice