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General NPI Number Information
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NPI Number | 1447744602
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Entity Type | Individual
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Provider Name | SHAUN RIZZO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 940 FRONTENAC DR
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City | WINONA
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State | MN
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Zip | 55987-6588
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Country | US
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Telephone | 507-494-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 535 19TH ST NW APT 33
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City | ROCHESTER
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State | MN
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Zip | 55901-8101
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Country | US
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Telephone | 507-272-9320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D14070
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License Number State | MN
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