Provider Demographics
NPI:1083715247
Name:RICE, KENNETH FLOYD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FLOYD
Last Name:RICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5500
Mailing Address - Country:US
Mailing Address - Phone:928-536-7159
Mailing Address - Fax:928-536-7150
Practice Address - Street 1:986 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5500
Practice Address - Country:US
Practice Address - Phone:928-536-7159
Practice Address - Fax:928-536-7150
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ384834Medicaid