Provider Demographics
NPI:1205131174
Name:RAINA DENTAL PC
Entity type:Organization
Organization Name:RAINA DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-548-8964
Mailing Address - Street 1:760 VILLAGE CENTER DR
Mailing Address - Street 2:240
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-4537
Mailing Address - Country:US
Mailing Address - Phone:913-548-8964
Mailing Address - Fax:
Practice Address - Street 1:136 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2852
Practice Address - Country:US
Practice Address - Phone:630-739-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190279481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty