Provider Demographics
NPI:1750698387
Name:RICE, JEREMY GRANT (DO, DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:GRANT
Last Name:RICE
Suffix:
Gender:M
Credentials:DO, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2206
Mailing Address - Country:US
Mailing Address - Phone:412-223-5880
Mailing Address - Fax:412-223-5883
Practice Address - Street 1:1416 MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2206
Practice Address - Country:US
Practice Address - Phone:412-779-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015291208D00000X
PADS0408081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice