Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 49 | SC |
NPI | 1003384132 |
---|---|
Provider Name | Dr. Fabio Rizzante |
First Address | Charleston, SC 29425-8908 |
Second Address | Charleston, SC 29425-4905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 04/02/2022 |