Healthcare Provider Details

I. General information

NPI: 1144397712
Provider Name (Legal Business Name): MARY RICE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 8TH ST SUITE 210
GRESHAM OR
97030-7317
US

IV. Provider business mailing address

421 SW OAK ST STE.210
PORTLAND OR
97204-1817
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-4900
  • Fax: 503-988-5803
Mailing address:
  • Phone: 503-988-7468
  • Fax: 503-988-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH1572
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: