Provider Demographics
NPI:1982681144
Name:BERRIDGE, JOHN WATSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WATSON
Last Name:BERRIDGE
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 1:3277 LOMA RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5511
Mailing Address - Country:US
Mailing Address - Phone:619-808-6417
Mailing Address - Fax:
Practice Address - Street 1:3277 LOMA RIVIERA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5511
Practice Address - Country:US
Practice Address - Phone:619-808-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist