Provider Demographics
NPI:1578713723
Name:RAINBOW DENTAL, PC
Entity Type:Organization
Organization Name:RAINBOW DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABILA
Authorized Official - Middle Name:YASMIN
Authorized Official - Last Name:MANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-433-0515
Mailing Address - Street 1:2533 36TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3209
Mailing Address - Country:US
Mailing Address - Phone:718-433-0515
Mailing Address - Fax:718-433-0515
Practice Address - Street 1:2533 36TH AVENUE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-3209
Practice Address - Country:US
Practice Address - Phone:718-433-0515
Practice Address - Fax:718-433-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047199-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01821127Medicaid