Provider Demographics
NPI:1700847043
Name:T.A. RAINBOLT, DDS, P.A.
Entity Type:Organization
Organization Name:T.A. RAINBOLT, DDS, P.A.
Other - Org Name:OTTAWA KANSAS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAINBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-841-3311
Mailing Address - Street 1:1425 WAKARUSA DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-841-3311
Mailing Address - Fax:785-843-0421
Practice Address - Street 1:1334 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067
Practice Address - Country:US
Practice Address - Phone:785-242-5753
Practice Address - Fax:785-242-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty