Provider Demographics
NPI:1467973206
Name:PIKE, RAINA (DMD)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:PIKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 HARTS MILL RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1815
Mailing Address - Country:US
Mailing Address - Phone:229-392-5942
Mailing Address - Fax:
Practice Address - Street 1:804 TOWN BLVD NE STE 2010
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3147
Practice Address - Country:US
Practice Address - Phone:404-631-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0154341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice