Provider Demographics
NPI:1912259631
Name:RAINER, CRAIG R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:RAINER
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 1:2613 GLENRIVER WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5178
Mailing Address - Country:US
Mailing Address - Phone:571-237-7982
Mailing Address - Fax:
Practice Address - Street 1:3533 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6830
Practice Address - Country:US
Practice Address - Phone:540-306-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014181351223G0001X
TX284581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice