Provider Demographics
NPI:1609543347
Name:RIAD, RAMEZ (DDS, MSC, BDS)
Entity Type:Individual
Prefix:
First Name:RAMEZ
Middle Name:
Last Name:RIAD
Suffix:
Gender:M
Credentials:DDS, MSC, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 PICCOLO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1715
Mailing Address - Country:US
Mailing Address - Phone:949-491-0640
Mailing Address - Fax:
Practice Address - Street 1:14051 NEWPORT AVE STE B2
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5171
Practice Address - Country:US
Practice Address - Phone:949-491-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist