Provider Demographics
NPI:1437456670
Name:RICK J. BERRIOS, DDS, INC.
Entity Type:Organization
Organization Name:RICK J. BERRIOS, DDS, INC.
Other - Org Name:OCEAN ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,
Authorized Official - Phone:714-841-4954
Mailing Address - Street 1:18800 MAIN ST
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty