Healthcare Provider Details

I. General information

NPI: 1760174858
Provider Name (Legal Business Name): ANGELINA MARIE RIZZUTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 7TH AVE S
BIRMINGHAM AL
35233-2005
US

IV. Provider business mailing address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3000
  • Fax:
Mailing address:
  • Phone: 908-914-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14049841
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: