Healthcare Provider Details

I. General information

NPI: 1720125842
Provider Name (Legal Business Name): JAN M RIZZO DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 WEST MICHIGAN AVENUE
CLINTON MI
49236
US

IV. Provider business mailing address

147 WEST MICHIGAN AVENUE P.O. BOX 349
CLINTON MI
49236
US

V. Phone/Fax

Practice location:
  • Phone: 517-456-7471
  • Fax:
Mailing address:
  • Phone: 517-456-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number13099
License Number StateMI

VIII. Authorized Official

Name: DR. JAN MICHAEL RIZZO
Title or Position: OWNER
Credential: DDS
Phone: 517-456-7471