=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427753342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK R. RICE, JR., DDS, P.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2023
-----------------------------------------------------
Last Update Date | 03/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2425 SCOTTSVILLE RD STE 120
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42104-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-393-4818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2425 SCOTTSVILLE RD STE 120
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42104-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-393-4818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK RICE JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 270-393-4818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------