MEDICARE: JASON MATTHEW RICE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D009560	AZ

General Provider Information

NPI Number	:	1265987192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON MATTHEW RICE DMD

Provider Business Mailing Address
First Line	:	1619 N DYSART RD STE 105
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1200
Country	:	US
Telephone Number	:	623-935-6278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 N DYSART RD STE 105
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-1200
Country	:	US
Telephone Number	:	623-935-6278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2016
Last Update Date	:	08/21/2016

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