Provider Demographics
NPI:1447744602
Name:RIZZO, SHAUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:RIZZO
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 1:535 19TH ST NW APT 33
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8101
Mailing Address - Country:US
Mailing Address - Phone:507-272-9320
Mailing Address - Fax:
Practice Address - Street 1:940 FRONTENAC DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6588
Practice Address - Country:US
Practice Address - Phone:507-494-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice