Basic Information
| Provider Information | |||||||||
| NPI: | 1568513802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISO | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY NW | ||||||||
| Address2: | SUITE 185 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619999650 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1857 N MILITARY TRL | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334094715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616837699 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | DN6971 | FL | Y | Dental Providers | Dentist | Endodontics |
No ID Information.