Provider Demographics
NPI:1235356981
Name:RIZMAN, KEITH H (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:H
Last Name:RIZMAN
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 1:929 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1559
Mailing Address - Country:US
Mailing Address - Phone:847-256-0019
Mailing Address - Fax:847-256-0089
Practice Address - Street 1:929 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1559
Practice Address - Country:US
Practice Address - Phone:847-256-0019
Practice Address - Fax:847-256-0089
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist