Healthcare Provider Details

I. General information

NPI: 1689727554
Provider Name (Legal Business Name): GOLY RICE HENRY JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CHERRY STREET
MARKS MS
38646-1209
US

IV. Provider business mailing address

304 CHERRY STREET
MARKS MS
38646-1209
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-8818
  • Fax: 662-326-2576
Mailing address:
  • Phone: 662-326-8818
  • Fax: 662-326-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number155973
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: