Provider Demographics
NPI:1063889954
Name:RIZZO, SOPHIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:RIZZO
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 1:11995 SINGLETREE LN STE 130
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5342
Mailing Address - Country:US
Mailing Address - Phone:507-269-2774
Mailing Address - Fax:
Practice Address - Street 1:11995 SINGLETREE LN STE 130
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5342
Practice Address - Country:US
Practice Address - Phone:507-269-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND139661223G0001X
NY0582261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice