Provider Demographics
NPI:1194349928
Name:RICE ORAL MAXILLOFACIAL SURGERY PC
Entity type:Organization
Organization Name:RICE ORAL MAXILLOFACIAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, DMD
Authorized Official - Phone:412-223-5880
Mailing Address - Street 1:1416 MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2206
Mailing Address - Country:US
Mailing Address - Phone:412-223-5880
Mailing Address - Fax:214-223-5883
Practice Address - Street 1:1416 MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2206
Practice Address - Country:US
Practice Address - Phone:412-779-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty