MEDICARE: E. THOMAS BICE, JR., D.D.S., P.A.

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	122300000X	Dentist	9277	TX
2	122300000X	Dentist	17059	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00704262	OTHER	TX	UNITED CONCORDIA
2	00191100	OTHER	TX	UNITED CONCORDIA
3	G-60093	OTHER	TX	TEXAS CHIP
4	D17059	OTHER	TX	BC/BS
5	00M240	OTHER	TX	BC/BS
6	B09277	OTHER	TX	TEXAS CHIP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831366400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E. THOMAS BICE, JR., D.D.S., P.A.

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	:	DENTIST/OWNER
Name	:	DR. ERNEST THOMAS BICE
Credential	:	D.D.S., P.A.
Telephone Number	:	210-435-4601

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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Directions to “E. THOMAS BICE, JR., D.D.S., P.A. ” Practice Location

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