Provider Demographics
NPI:1679741284
Name:RIZZUTO, BART M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:M
Last Name:RIZZUTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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:518-382-2569
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:518-382-2569
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0442031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044203OtherLICENSE