Provider Demographics
NPI:1821830001
Name:RIZKALLA, MARLY (DDS)
Entity type:Individual
Prefix:
First Name:MARLY
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 SCHEEL LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3471
Mailing Address - Country:US
Mailing Address - Phone:317-410-7014
Mailing Address - Fax:
Practice Address - Street 1:1650 N COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1715
Practice Address - Country:US
Practice Address - Phone:317-880-0888
Practice Address - Fax:317-880-0886
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014479A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice