MEDICARE: GEORGE RIZKALLA

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
1	1223G0001X	General Practice Dentistry	D12012	MN

General Provider Information

NPI Number	:	1326038209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE RIZKALLA

Provider Business Mailing Address
First Line	:	5100 EDEN AVE
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55436-2337
Country	:	US
Telephone Number	:	952-929-0641
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2443
Country	:	US
Telephone Number	:	952-929-0641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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