MEDICARE: DR. ERNEST THOMAS BICE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17059	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00191100	OTHER	TX	UNITED CONCORDIA
2	D17059	OTHER	TX	BC/BS PROVIDER ID
3	G60093-01	OTHER	TX	TEXAS CHIP PROVIDER ID

General Provider Information

NPI Number	:	1487762241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST THOMAS BICE D.D.S.

Provider Business Mailing Address
First Line	:	4496 CALLAGHAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-3400
Country	:	US
Telephone Number	:	210-435-4601
Fax Number	:	210-435-7131

Provider Business Practice Location Address
First Line	:	4496 CALLAGHAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-3400
Country	:	US
Telephone Number	:	210-435-4601
Fax Number	:	210-435-7131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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