Provider Demographics
NPI:1184671281
Name:J. RICE ORAL MAXILLOFACIAL AND AESTHETIC FACIAL SURGERY P.C.
Entity Type:Organization
Organization Name:J. RICE ORAL MAXILLOFACIAL AND AESTHETIC FACIAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-375-0500
Mailing Address - Street 1:90 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2440
Mailing Address - Country:US
Mailing Address - Phone:814-375-0500
Mailing Address - Fax:814-375-0124
Practice Address - Street 1:90 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2440
Practice Address - Country:US
Practice Address - Phone:814-375-0500
Practice Address - Fax:814-375-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014604560001Medicaid
PA096142Medicare PIN