Provider Demographics
NPI:1982861324
Name:MOHRLOCK, RICHARD DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DENNIS
Last Name:MOHRLOCK
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 1:2067 W VISTA WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6033
Mailing Address - Country:US
Mailing Address - Phone:760-967-9777
Mailing Address - Fax:760-295-8991
Practice Address - Street 1:2067 W VISTA WAY STE 190
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6033
Practice Address - Country:US
Practice Address - Phone:760-967-9777
Practice Address - Fax:760-295-8991
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist