Provider Demographics
NPI:1396375283
Name:J. STEPHEN RAINES DDS PLLC
Entity type:Organization
Organization Name:J. STEPHEN RAINES DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-833-0599
Mailing Address - Street 1:216 E CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3418
Mailing Address - Country:US
Mailing Address - Phone:870-833-0599
Mailing Address - Fax:
Practice Address - Street 1:216 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3418
Practice Address - Country:US
Practice Address - Phone:870-833-0599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental