Provider Demographics
NPI:1871616334
Name:RICE, MARTHA R (DMD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:R
Last Name:RICE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1251
Mailing Address - Country:US
Mailing Address - Phone:859-873-7183
Mailing Address - Fax:859-873-7183
Practice Address - Street 1:240 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1251
Practice Address - Country:US
Practice Address - Phone:859-873-7183
Practice Address - Fax:859-873-7183
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60053006Medicaid