Provider Demographics
NPI:1730720780
Name:SMILESFROMRAINAPLLC
Entity type:Organization
Organization Name:SMILESFROMRAINAPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GAYATRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:936-422-4211
Mailing Address - Street 1:1202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949-8424
Mailing Address - Country:US
Mailing Address - Phone:225-202-9446
Mailing Address - Fax:936-876-5795
Practice Address - Street 1:1202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:TX
Practice Address - Zip Code:75949-8424
Practice Address - Country:US
Practice Address - Phone:225-202-9446
Practice Address - Fax:936-876-5795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILESFROMRAINAPLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies