Provider Demographics
NPI:1053534180
Name:BERRIOS, RICK J (DDS)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:J
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 MAIN ST
Mailing Address - Street 2:# 205
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1707
Mailing Address - Country:US
Mailing Address - Phone:714-841-4954
Mailing Address - Fax:714-841-4964
Practice Address - Street 1:18800 MAIN ST
Practice Address - Street 2:205
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1707
Practice Address - Country:US
Practice Address - Phone:714-841-4954
Practice Address - Fax:714-841-4964
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349311223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology