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General NPI Number Information
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NPI Number | 1477625184
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL SERVICES LTD
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1185 CAVE SPRINGS ESTATE DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-6529
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Country | US
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Telephone | 636-757-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 CAVE SPRINGS ESTATE DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-6529
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Country | US
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Telephone | 636-757-1800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBERT T RIZZUTI
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Credential | D.M.D.
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Telephone | 636-757-1800
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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 | 13015
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License Number State | MO
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