Provider Demographics
NPI:1477625184
Name:FAMILY DENTAL SERVICES LTD
Entity Type:Organization
Organization Name:FAMILY DENTAL SERVICES LTD
Other - Org Name:FAMILY DENTAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:RIZZUTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-757-1800
Mailing Address - Street 1:1185 CAVE SPRINGS ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6529
Mailing Address - Country:US
Mailing Address - Phone:636-757-1800
Mailing Address - Fax:
Practice Address - Street 1:1185 CAVE SPRINGS ESTATE DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6529
Practice Address - Country:US
Practice Address - Phone:636-757-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty