Provider Demographics
NPI:1669487468
Name:BAINS, RENA (DDS)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:BAINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ST. PAULS WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3390
Mailing Address - Country:US
Mailing Address - Phone:209-578-4153
Mailing Address - Fax:209-578-0725
Practice Address - Street 1:2301 ST. PAULS WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3390
Practice Address - Country:US
Practice Address - Phone:209-578-4153
Practice Address - Fax:209-578-0725
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics