Provider Demographics
NPI:1962601971
Name:RISSIN, LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:RISSIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 TURNPIKE ST
Mailing Address - Street 2:SUITE 64
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5922
Mailing Address - Country:US
Mailing Address - Phone:978-686-2620
Mailing Address - Fax:
Practice Address - Street 1:565 TURNPIKE ST
Practice Address - Street 2:SUITE 64
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5922
Practice Address - Country:US
Practice Address - Phone:978-686-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115691223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics