Provider Demographics
NPI:1417922733
Name:RAINEY, J TIM I (DDS)
Entity Type:Individual
Prefix:DR
First Name:J TIM
Middle Name:
Last Name:RAINEY
Suffix:I
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 1044
Mailing Address - Street 2:
Mailing Address - City:REFUGIO
Mailing Address - State:TX
Mailing Address - Zip Code:78377-1044
Mailing Address - Country:US
Mailing Address - Phone:361-526-4695
Mailing Address - Fax:361-526-4697
Practice Address - Street 1:606 OSAGE ST
Practice Address - Street 2:
Practice Address - City:REFUGIO
Practice Address - State:TX
Practice Address - Zip Code:78377-3229
Practice Address - Country:US
Practice Address - Phone:361-526-4695
Practice Address - Fax:361-526-4697
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00095361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAR4544753OtherDEA #