=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164123204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EFTIXIA RIZOV DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2023
-----------------------------------------------------
Last Update Date | 05/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13440 SPRINGFIELD BLVD
-----------------------------------------------------
City | SPRINGFIELD GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11413-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-242-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 FLINTWOOD CT.
-----------------------------------------------------
City | TORONTO
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | M2J 3P1
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 06485701
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------