Provider Demographics
NPI:1821178062
Name:O'BRAITIS, RICHARD JOSEPH
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:O'BRAITIS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:O'BRAITIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:24000 ALICIA PKWY STE 32
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3929
Mailing Address - Country:US
Mailing Address - Phone:949-770-9533
Mailing Address - Fax:949-462-3704
Practice Address - Street 1:24000 ALICIA PKWY STE 32
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3929
Practice Address - Country:US
Practice Address - Phone:949-770-9533
Practice Address - Fax:949-462-3704
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist