Provider Demographics
NPI:1437278314
Name:RIZKALLA DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:RIZKALLA DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:JARUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-746-1840
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129301223G0001X
MA20101201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty