Provider Demographics
NPI:1770928442
Name:RAINWATER, DAVID MITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MITCHELL
Last Name:RAINWATER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COMBONNE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5513
Mailing Address - Country:US
Mailing Address - Phone:479-790-0494
Mailing Address - Fax:501-224-2405
Practice Address - Street 1:12921 CANTRELL RD STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1709
Practice Address - Country:US
Practice Address - Phone:501-224-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice