Provider Demographics
NPI:1831366400
Name:E. THOMAS BICE, JR., D.D.S., P.A.
Entity type:Organization
Organization Name:E. THOMAS BICE, JR., D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:210-435-4601
Mailing Address - Street 1:4496 CALLAGHAN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3400
Mailing Address - Country:US
Mailing Address - Phone:210-435-4601
Mailing Address - Fax:210-435-7131
Practice Address - Street 1:4496 CALLAGHAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3400
Practice Address - Country:US
Practice Address - Phone:210-435-4601
Practice Address - Fax:210-435-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9277122300000X
TX17059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00704262OtherUNITED CONCORDIA
TX00191100OtherUNITED CONCORDIA
TXG-60093OtherTEXAS CHIP
TXD17059OtherBC/BS
TX00M240OtherBC/BS
TXB09277OtherTEXAS CHIP
TX007987301Medicaid
TX090184502Medicaid