Provider Demographics
NPI:1770746372
Name:MOUHAB Z RIZKALLAH DDS MSD PC
Entity type:Organization
Organization Name:MOUHAB Z RIZKALLAH DDS MSD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUHAB
Authorized Official - Middle Name:Z
Authorized Official - Last Name:RIZKALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD PC
Authorized Official - Phone:617-591-9999
Mailing Address - Street 1:30 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1914
Mailing Address - Country:US
Mailing Address - Phone:617-591-9999
Mailing Address - Fax:617-591-9990
Practice Address - Street 1:30 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1914
Practice Address - Country:US
Practice Address - Phone:617-591-9999
Practice Address - Fax:617-591-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty