Active NPI
Colden Douglas Raines Jr., DDS
- Dentist
- Newark, NJ
National Provider Identifier
1053494187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22D101769300
- Practice address
- 603 Clinton Ave
Newark, NJ 07108 - Phone
- (973) 824-7409
- Fax
- (973) 824-7430
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22D101769300 | NJ | Primary |
Addresses
Primary practice location
603 Clinton Ave
Newark, NJ 07108
Mailing address
603 Clinton Ave
Newark, NJ 07108
Phone (973) 824-7409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22D101769300 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1053494187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 CLINTON AVE",
"city": "NEWARK",
"state": "NJ",
"postal_code": "07108",
"telephone_number": "973-824-7409",
"fax_number": "973-824-7430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 CLINTON AVE",
"city": "NEWARK",
"state": "NJ",
"postal_code": "07108",
"telephone_number": "973-824-7409",
"fax_number": "973-824-7430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAINES",
"first_name": "COLDEN",
"middle_name": "DOUGLAS",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22D101769300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.