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General NPI Number Information
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NPI Number | 1720125842
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Entity Type | Organization
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Legal Business Name | JAN M RIZZO DDS PC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 147 WEST MICHIGAN AVENUE
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City | CLINTON
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State | MI
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Zip | 49236
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Country | US
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Telephone | 517-456-7471
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Fax |
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Provider Business Mailing Address
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Address Line | 147 WEST MICHIGAN AVENUE P.O. BOX 349
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City | CLINTON
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State | MI
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Zip | 49236
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Country | US
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Telephone | 517-456-7471
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAN MICHAEL RIZZO
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Credential | DDS
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Telephone | 517-456-7471
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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 | 13099
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License Number State | MI
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