Provider Demographics
NPI:1841255494
Name:RICE, ALECIA MATHOG (DDS)
Entity type:Individual
Prefix:DR
First Name:ALECIA
Middle Name:MATHOG
Last Name:RICE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TIBY
Other - Middle Name:ALECIA
Other - Last Name:MATHOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:43200 DEQUINDRE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1707
Mailing Address - Country:US
Mailing Address - Phone:248-910-0019
Mailing Address - Fax:
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:248-910-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21603122300000X
MI2901019210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist