Provider Demographics
NPI:1780988030
Name:BREST VICO, RAMON ALFREDO (DDS)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:ALFREDO
Last Name:BREST VICO
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 1:2940 E THOUSAND OAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3291
Mailing Address - Country:US
Mailing Address - Phone:805-409-9009
Mailing Address - Fax:
Practice Address - Street 1:2940 E THOUSAND OAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-3291
Practice Address - Country:US
Practice Address - Phone:805-409-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice