MEDICARE: DR. JEFFREY S RIZZO 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
1	1223G0001X	General Practice Dentistry	DN 15352	FL

General Provider Information

NPI Number	:	1790813772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY S RIZZO DMD

Provider Business Mailing Address
First Line	:	6150 METROWEST BLVD
Second Line	:	#207
City	:	ORLANDO
State	:	FL
Zip	:	32835-3289
Country	:	US
Telephone Number	:	407-521-8765
Fax Number	:	407-521-0628

Provider Business Practice Location Address
First Line	:	6150 METROWEST BLVD
Second Line	:	#207
City	:	ORLANDO
State	:	FL
Zip	:	32835-3289
Country	:	US
Telephone Number	:	407-521-8765
Fax Number	:	407-521-0628

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	11/25/2015

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