MEDICARE: DR. KRIS EUGENE RICE D.M.D.

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	5815	OR

General Provider Information

NPI Number	:	1912904889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRIS EUGENE RICE D.M.D.

Provider Business Mailing Address
First Line	:	10340 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-1253
Country	:	US
Telephone Number	:	503-256-3199
Fax Number	:	503-256-9383

Provider Business Practice Location Address
First Line	:	10340 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-1253
Country	:	US
Telephone Number	:	503-256-3199
Fax Number	:	503-256-9383

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/08/2007

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