Provider Demographics
NPI:1821597626
Name:RICE PROFESSIONAL DENTAL CORPORTION
Entity Type:Organization
Organization Name:RICE PROFESSIONAL DENTAL CORPORTION
Other - Org Name:TURLOCK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-668-4013
Mailing Address - Street 1:3950 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1147
Mailing Address - Country:US
Mailing Address - Phone:209-668-4013
Mailing Address - Fax:209-656-9744
Practice Address - Street 1:3950 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1147
Practice Address - Country:US
Practice Address - Phone:209-668-4013
Practice Address - Fax:209-656-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41529261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental