Provider Demographics
NPI:1063618213
Name:CHADWELL, RAINEY F (DMD)
Entity type:Individual
Prefix:
First Name:RAINEY
Middle Name:F
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SQUIRES PT
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8869
Mailing Address - Country:US
Mailing Address - Phone:864-486-1888
Mailing Address - Fax:864-486-8688
Practice Address - Street 1:914 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2126
Practice Address - Country:US
Practice Address - Phone:864-489-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC929839Medicaid