Provider Demographics
NPI:1528805579
Name:CLEARFIELD ORAL FACIAL AND IMPLANT SURGERY PC
Entity type:Organization
Organization Name:CLEARFIELD ORAL FACIAL AND IMPLANT SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
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:412-223-5883
Practice Address - Street 1:90 BEAVER DR STE 209D
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2449
Practice Address - Country:US
Practice Address - Phone:412-223-5880
Practice Address - Fax:412-223-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty