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General NPI Number Information
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NPI Number | 1891043477
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Entity Type | Organization
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Legal Business Name | DEANNA RISOS DMD,PC.
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 841 KUHN DR. STE # 102
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City | CHULA VISTA
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State | CA
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Zip | 91914
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Country | US
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Telephone | 619-482-8880
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Fax | 619-482-0099
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Provider Business Mailing Address
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Address Line | 841 KUHN DR. STE # 102
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City | CHULA VISTA
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State | CA
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Zip | 91914
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Country | US
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Telephone | 619-482-8880
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Fax | 619-482-0099
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Authorized Official
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Title or Position | DENTIST
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Name | DEANNA RISOS
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Credential | DMD
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Telephone | 619-482-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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