Provider Demographics
NPI:1851591036
Name:MIZOGUCHI, RITSUKO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RITSUKO
Middle Name:
Last Name:MIZOGUCHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ATTUCKS LN
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1867
Mailing Address - Country:US
Mailing Address - Phone:508-778-0300
Mailing Address - Fax:508-778-8747
Practice Address - Street 1:735 ATTUCKS LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1867
Practice Address - Country:US
Practice Address - Phone:508-778-0300
Practice Address - Fax:508-778-8747
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist