Basic Information
Provider Information
NPI: 1790977270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICE
FirstName: TONYA
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8522 N LAMAR BLVD
Address2:  
City: AUSTIN
State: TX
PostalCode: 787535543
CountryCode: US
TelephoneNumber: 5128326225
FaxNumber: 5128328454
Practice Location
Address1: 8522 N LAMAR BLVD
Address2:  
City: AUSTIN
State: TX
PostalCode: 787535543
CountryCode: US
TelephoneNumber: 5128326225
FaxNumber: 5128328454
Other Information
ProviderEnumerationDate: 08/17/2007
LastUpdateDate: 08/17/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X23536TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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