Provider Demographics
NPI:1831453877
Name:MIZRAHI, RITA (DDS)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:MIZRAHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 BRUSH HOLLOW RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1778
Mailing Address - Country:US
Mailing Address - Phone:516-333-5900
Mailing Address - Fax:
Practice Address - Street 1:959 BRUSH HOLLOW RD
Practice Address - Street 2:STE 102
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1778
Practice Address - Country:US
Practice Address - Phone:516-333-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02506100122300000X
NY50 0586831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist