Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 14651 | MD |
Y | 1223X0400X | Orthodontists | 2901021142 | MI |
NPI | 1033340070 |
---|---|
Provider Name | Susan Rizk |
First Address | West Bloomfield, MI 48322-1392 |
Second Address | Lathrup Village, MI 48076-4725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 07/12/2016 |