Provider Demographics
NPI:1053562629
Name:RAINS, BROOKE KONDO (DDS)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:KONDO
Last Name:RAINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S. GREEN VALLEY RD.
Mailing Address - Street 2:#2
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076
Mailing Address - Country:US
Mailing Address - Phone:831-728-1322
Mailing Address - Fax:831-728-2778
Practice Address - Street 1:390 S. GREEN VALLEY RD.
Practice Address - Street 2:#2
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-728-1322
Practice Address - Fax:831-728-2778
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice