Provider Demographics
NPI:1255732046
Name:DEANNA RISOS DMD PC
Entity type:Organization
Organization Name:DEANNA RISOS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:RISOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-482-8880
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 STE 102
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4523
Practice Address - Country:US
Practice Address - Phone:619-482-8880
Practice Address - Fax:619-482-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50416335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier