Healthcare Provider Details

I. General information

NPI: 1184671281
Provider Name (Legal Business Name): J. RICE ORAL MAXILLOFACIAL AND AESTHETIC FACIAL SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BEAVER DR
DU BOIS PA
15801-2440
US

IV. Provider business mailing address

90 BEAVER DR
DU BOIS PA
15801-2440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-0500
  • Fax: 814-375-0124
Mailing address:
  • Phone: 814-375-0500
  • Fax: 814-375-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY W RICE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 814-375-0500