Provider Demographics
NPI:1447772793
Name:RICE, THOMAS DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DAVID
Last Name:RICE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 MEDICAL DR APT 23106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5668
Mailing Address - Country:US
Mailing Address - Phone:817-944-4984
Mailing Address - Fax:
Practice Address - Street 1:109 E AVENUE J
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-2347
Practice Address - Country:US
Practice Address - Phone:361-248-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice