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General NPI Number Information
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NPI Number | 1487333282
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Entity Type | Organization
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Legal Business Name | HASSAN & RIZKALLA DENTAL PLLC
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 4434 W FULLERTON AVE APT 405
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City | CHICAGO
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State | IL
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Zip | 60639-1932
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Country | US
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Telephone | 347-977-3608
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Fax |
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Provider Business Mailing Address
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Address Line | 2421 OAK TREE LN
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City | PARK RIDGE
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State | IL
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Zip | 60068-1521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE RIZKALLA
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Credential | DMD
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Telephone | 347-977-3608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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