Healthcare Provider Details

I. General information

NPI: 1194891978
Provider Name (Legal Business Name): MARVIN ELWOOD RICE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MEDICAL PARK DR
MEXICO MO
65265-3727
US

IV. Provider business mailing address

703 MEDICAL PARK DR
MEXICO MO
65265-3727
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-7660
  • Fax: 573-581-0788
Mailing address:
  • Phone: 573-581-7660
  • Fax: 573-581-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number013730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: