Provider Demographics
NPI:1790811024
Name:RIZK, FRED R (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:R
Last Name:RIZK
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 1:1923 NEBRASKA STREET
Mailing Address - Street 2:
Mailing Address - City:SIUOX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104
Mailing Address - Country:US
Mailing Address - Phone:712-258-7734
Mailing Address - Fax:712-258-9054
Practice Address - Street 1:1923 NEBRASKA STREET
Practice Address - Street 2:
Practice Address - City:SIUOX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:712-258-7734
Practice Address - Fax:712-258-9054
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0123539Medicaid
NE10025084800Medicaid