Provider Demographics
NPI:1548564289
Name:CAPITAL DISTRICT ENDODONTICS, PC
Entity Type:Organization
Organization Name:CAPITAL DISTRICT ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-377-1234
Mailing Address - Street 1:2317 BALLTOWN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2339
Mailing Address - Country:US
Mailing Address - Phone:518-377-1234
Mailing Address - Fax:
Practice Address - Street 1:2317 BALLTOWN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2339
Practice Address - Country:US
Practice Address - Phone:518-377-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0442031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048904OtherDDS
NY044203OtherDDS