Provider Demographics
NPI:1477064004
Name:RAINES, JAMES STEPHEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEPHEN
Last Name:RAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 DESOTO BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909
Mailing Address - Country:US
Mailing Address - Phone:501-922-1045
Mailing Address - Fax:
Practice Address - Street 1:1396 DESOTO BLVD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-7633
Practice Address - Country:US
Practice Address - Phone:501-922-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist