MEDICARE: DR. RUBA FAKHOURY RIZQALLA D.D.S.

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	053540	NY

General Provider Information

NPI Number	:	1750408324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBA FAKHOURY RIZQALLA D.D.S.

Provider Business Mailing Address
First Line	:	105 SHAD ROW
Second Line	:	SUITE 1A
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	845-359-6315
Fax Number	:	845-359-4788

Provider Business Practice Location Address
First Line	:	105 SHAD ROW
Second Line	:	SUITE 1A
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	845-359-6315
Fax Number	:	845-359-4788

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/23/2016

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