Healthcare Provider Details

I. General information

NPI: 1487333282
Provider Name (Legal Business Name): HASSAN & RIZKALLA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4434 W FULLERTON AVE APT 405
CHICAGO IL
60639-1932
US

IV. Provider business mailing address

2421 OAK TREE LN
PARK RIDGE IL
60068-1521
US

V. Phone/Fax

Practice location:
  • Phone: 347-977-3608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGE RIZKALLA
Title or Position: PRESIDENT
Credential: DMD
Phone: 347-977-3608