Provider Demographics
NPI:1104849041
Name:RISOS, DEANNA B (DMD)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:B
Last Name:RISOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 KUHN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4523
Mailing Address - Country:US
Mailing Address - Phone:619-482-8880
Mailing Address - Fax:619-482-0099
Practice Address - Street 1:841 KUHN DR
Practice Address - Street 2:SUITE # 102
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3552
Practice Address - Country:US
Practice Address - Phone:619-482-8880
Practice Address - Fax:619-482-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice