Provider Demographics
NPI:1649530726
Name:J TIM RAINEY, DDS, P.C.
Entity type:Organization
Organization Name:J TIM RAINEY, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-526-4695
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:REFUGIO
Mailing Address - State:TX
Mailing Address - Zip Code:78377-1044
Mailing Address - Country:US
Mailing Address - Phone:361-526-4695
Mailing Address - Fax:361-526-4697
Practice Address - Street 1:606 OSAGE ST
Practice Address - Street 2:
Practice Address - City:REFUGIO
Practice Address - State:TX
Practice Address - Zip Code:78377-3229
Practice Address - Country:US
Practice Address - Phone:361-526-4695
Practice Address - Fax:361-526-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085409-02Medicaid