Provider Demographics
NPI:1336222116
Name:RAYNES, CHRISTEN SIMPSON (DDS, MBA)
Entity Type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:SIMPSON
Last Name:RAYNES
Suffix:
Gender:F
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:KEELY
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MBA
Mailing Address - Street 1:400 ALLEN DRIVE, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302
Mailing Address - Country:US
Mailing Address - Phone:304-342-6162
Mailing Address - Fax:304-342-8309
Practice Address - Street 1:400 ALLEN DRIVE, SUITE 300
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-342-6162
Practice Address - Fax:304-342-8309
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV37111223G0001X
WV37111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550538620OtherEMPLOYER IDENTIFICATION #
WV001844461OtherBLUE CROSS & BLUE SHIELD