Provider Demographics
NPI:1649483447
Name:RAINGE, LOUVENIA ANNETTE (DMD)
Entity type:Individual
Prefix:
First Name:LOUVENIA
Middle Name:ANNETTE
Last Name:RAINGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 LUMPKIN RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3594
Mailing Address - Country:US
Mailing Address - Phone:706-790-4060
Mailing Address - Fax:706-790-0762
Practice Address - Street 1:2139 LUMPKIN RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3594
Practice Address - Country:US
Practice Address - Phone:706-790-4060
Practice Address - Fax:706-790-0762
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00433925AMedicaid
GA58-2045758OtherEIN