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NPI Code Detail

MEDICARE: NICOLE ANGELA RIZZUTO DMD

MEDICARE: NICOLE ANGELA RIZZUTO DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1023969581
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ANGELA RIZZUTO DMD
Provider Business Mailing Address
First Line : 101 SOUTH DRIVE
Second Line :
City : STONY BROOK
State : NY
Zip : 11794-0001
Country : US
Telephone Number : 631-632-8989
Fax Number :
Provider Business Practice Location Address
First Line : 101 SOUTH DRIVE
Second Line :
City : STONY BROOK
State : NY
Zip : 11794-0001
Country : US
Telephone Number : 631-632-8989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ NICOLE ANGELA RIZZUTO DMD” Practice Location

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