Provider Demographics
NPI:1811060106
Name:RAINVILLE, JOHN E (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:RAINVILLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEBORRAH
Other - Middle Name:J
Other - Last Name:NORDBLOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:212 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3144
Mailing Address - Country:US
Mailing Address - Phone:507-285-1121
Mailing Address - Fax:507-285-5384
Practice Address - Street 1:212 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3144
Practice Address - Country:US
Practice Address - Phone:507-285-1121
Practice Address - Fax:507-285-5384
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND101591223G0001X
MND101011223G0001X
MNH5638124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered124Q00000XDental ProvidersDental Hygienist