Provider Demographics
NPI:1629084819
Name:RIZZO, GERALD VINCENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:VINCENT
Last Name:RIZZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 HACKENSACK ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1311
Mailing Address - Country:US
Mailing Address - Phone:201-939-5770
Mailing Address - Fax:
Practice Address - Street 1:445 HACKENSACK ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1311
Practice Address - Country:US
Practice Address - Phone:201-939-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI187011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice