Provider Demographics
NPI:1316292501
Name:RICE, JESSICA COLLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:COLLEEN
Last Name:RICE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 MERCANTILE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3595
Mailing Address - Country:US
Mailing Address - Phone:214-636-5946
Mailing Address - Fax:
Practice Address - Street 1:3975 MERCANTILE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3595
Practice Address - Country:US
Practice Address - Phone:503-636-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice