Provider Demographics
NPI:1184194565
Name:RIZER, KAYLA LEE (RDH, RDA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:LEE
Last Name:RIZER
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9075
Mailing Address - Country:US
Mailing Address - Phone:989-295-4217
Mailing Address - Fax:
Practice Address - Street 1:816 JOSLYN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2919
Practice Address - Country:US
Practice Address - Phone:248-758-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018457124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist