Provider Demographics
NPI:1740417682
Name:RAINA, GAYATRI (DMD)
Entity Type:Individual
Prefix:DR
First Name:GAYATRI
Middle Name:
Last Name:RAINA
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 1:1202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949-8424
Mailing Address - Country:US
Mailing Address - Phone:936-422-4211
Mailing Address - Fax:936-867-5795
Practice Address - Street 1:1202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:TX
Practice Address - Zip Code:75949
Practice Address - Country:US
Practice Address - Phone:936-422-4211
Practice Address - Fax:936-867-5795
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245221223G0001X
ORD10010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist