Provider Demographics
NPI:1619224300
Name:RICE, MICHAEL MACY (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MACY
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 1:1820 SONOMA AVE
Mailing Address - Street 2:STE. 20
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6616
Mailing Address - Country:US
Mailing Address - Phone:707-578-7701
Mailing Address - Fax:707-578-8146
Practice Address - Street 1:1820 SONOMA AVE
Practice Address - Street 2:STE. 20
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6616
Practice Address - Country:US
Practice Address - Phone:707-578-7701
Practice Address - Fax:707-578-8146
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282311223G0001X
CA621141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice