Provider Demographics
NPI:1083639223
Name:RIZKALLA, BAHAA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAHAA
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3382
Mailing Address - Country:US
Mailing Address - Phone:508-746-1840
Mailing Address - Fax:508-746-7318
Practice Address - Street 1:24 NORTH ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3382
Practice Address - Country:US
Practice Address - Phone:508-746-1840
Practice Address - Fax:508-746-7318
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA38120OtherHARVARD PILGRIM
MAX11381OtherBLU CROSS OF MA