Provider Demographics
NPI:1003034059
Name:SUAREZ, RICARDO ANDRES (DDS)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANDRES
Last Name:SUAREZ
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 1:15732 MAR VISTA ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1325
Mailing Address - Country:US
Mailing Address - Phone:626-919-4337
Mailing Address - Fax:626-919-2300
Practice Address - Street 1:100 S VINCENT AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2902
Practice Address - Country:US
Practice Address - Phone:626-919-4337
Practice Address - Fax:626-919-2300
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice