Provider Demographics
NPI:1750457222
Name:RAINES, KEVIN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:RAINES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WHITEFORD WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7965
Mailing Address - Country:US
Mailing Address - Phone:803-951-9100
Mailing Address - Fax:803-951-1910
Practice Address - Street 1:139 WHITEFORD WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7965
Practice Address - Country:US
Practice Address - Phone:803-951-9100
Practice Address - Fax:803-951-1910
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3453-0523PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3453Medicaid