Healthcare Provider Details

I. General information

NPI: 1528524188
Provider Name (Legal Business Name): RICKY SINGH DMD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 THE ALAMEDA
BERKELEY CA
94707-2308
US

IV. Provider business mailing address

914 THE ALAMEDA
BERKELEY CA
94707-2308
US

V. Phone/Fax

Practice location:
  • Phone: 520-524-6234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICKY SINGH
Title or Position: OWNER
Credential:
Phone: 510-524-6234