Basic Information
Provider Information
NPI: 1932197787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICE
FirstName: CRAIG
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 SHOFF LN
Address2:  
City: MELBOURNE
State: FL
PostalCode: 329407482
CountryCode: US
TelephoneNumber: 3212553016
FaxNumber:  
Practice Location
Address1: 1381 S PATRICK DR
Address2:  
City: PATRICK AFB
State: FL
PostalCode: 329253606
CountryCode: US
TelephoneNumber: 3214946366
FaxNumber: 3214941378
Other Information
ProviderEnumerationDate: 10/06/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDN10963FLY Dental ProvidersDentist 

No ID Information.


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