Provider Demographics
NPI:1356763122
Name:RAINBOW DENTAL CLINIC LLC
Entity type:Organization
Organization Name:RAINBOW DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RINALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-784-5801
Mailing Address - Street 1:418 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2111
Mailing Address - Country:US
Mailing Address - Phone:208-784-5801
Mailing Address - Fax:208-783-6011
Practice Address - Street 1:418 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2111
Practice Address - Country:US
Practice Address - Phone:208-784-5801
Practice Address - Fax:208-783-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD19231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396810255OtherINDIVIDUAL NPI