MEDICARE: DR. JEREMY GRANT RICE D.O., D.M.D.

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	208D00000X	General Practice Physician	OS015291	PA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS040808	PA

General Provider Information

NPI Number	:	1750698387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY GRANT RICE D.O., D.M.D.

Provider Business Mailing Address
First Line	:	1416 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2206
Country	:	US
Telephone Number	:	412-223-5880
Fax Number	:	412-223-5883

Provider Business Practice Location Address
First Line	:	1416 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2206
Country	:	US
Telephone Number	:	412-779-0620
Fax Number	:

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	04/03/2022

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