Provider Demographics
NPI:1982763579
Name:BERES, BRIAN N (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:N
Last Name:BERES
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:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-0858
Mailing Address - Country:US
Mailing Address - Phone:805-929-3277
Mailing Address - Fax:805-929-1106
Practice Address - Street 1:255 N WILSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-0858
Practice Address - Country:US
Practice Address - Phone:805-929-3277
Practice Address - Fax:805-929-1106
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist