Provider Demographics
NPI:1285857557
Name:RICE, ELLIOTT FERGUSON (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:FERGUSON
Last Name:RICE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1128
Mailing Address - Country:US
Mailing Address - Phone:440-576-0711
Mailing Address - Fax:440-576-5621
Practice Address - Street 1:248 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1128
Practice Address - Country:US
Practice Address - Phone:440-576-0711
Practice Address - Fax:440-576-5621
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice