Individual provider Active NPI

Deanna B Risos, DMD

  • General Practice Dentistry
  • Chula Vista, CA
National Provider Identifier
1104849041
Registry record updated Aug 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
50416 Issued in CA
Practice address
841 Kuhn Dr
Suite # 102
Chula Vista, CA 91914-3552
Phone
(619) 482-8880
Fax
(619) 482-0099
NPI assigned
Jul 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 50416 CA Primary

Addresses

Primary practice location

841 Kuhn Dr
Suite # 102
Chula Vista, CA 91914-3552

Mailing address

841 Kuhn Dr Ste 102
Chula Vista, CA 91914-4523
Phone (619) 482-8880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151022001344 CA Practitioner - Oral Surgery 7315262771

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50416CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Deanna Risos DMD,PC. General Practice PastSince Sep 30, 2015 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345161600000",
    "number": "1104849041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 KUHN DR STE 102",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919144523",
            "telephone_number": "619-482-8880",
            "fax_number": "619-482-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 KUHN DR",
            "address_2": "SUITE # 102",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919143552",
            "telephone_number": "619-482-8880",
            "fax_number": "619-482-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISOS",
        "first_name": "DEANNA",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2012-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.