Provider Demographics
NPI:1841718764
Name:RICE, SHELBY LEIGH
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LEIGH
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 HOGAN BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-1928
Mailing Address - Country:US
Mailing Address - Phone:570-748-6450
Mailing Address - Fax:570-748-6451
Practice Address - Street 1:266 HOGAN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1928
Practice Address - Country:US
Practice Address - Phone:570-748-6450
Practice Address - Fax:570-748-6451
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDHP000546124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist