Provider Demographics
NPI:1609843804
Name:RAINES-HART, CYNTHIA LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:RAINES-HART
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 1:11631 ASHEVILLE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-1855
Mailing Address - Country:US
Mailing Address - Phone:864-472-8308
Mailing Address - Fax:864-472-2033
Practice Address - Street 1:11631 ASHEVILLE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-1855
Practice Address - Country:US
Practice Address - Phone:864-472-8308
Practice Address - Fax:864-472-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ33739Medicaid