Provider Demographics
NPI:1861668055
Name:J TIM RAINEY, II, D.D.S., P.C.
Entity Type:Organization
Organization Name:J TIM RAINEY, II, D.D.S., P.C.
Other - Org Name:LIFETIME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:TIM
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-249-9300
Mailing Address - Street 1:1414 E BLANCO RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1831
Mailing Address - Country:US
Mailing Address - Phone:830-249-9300
Mailing Address - Fax:830-249-9330
Practice Address - Street 1:1414 E BLANCO RD
Practice Address - Street 2:SUITE 16
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1831
Practice Address - Country:US
Practice Address - Phone:830-249-9300
Practice Address - Fax:830-249-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty