Provider Demographics
NPI:1861565491
Name:BERRIOS, ROBERT D (DDS, MS,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:DDS, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8345 RESEDA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5952
Mailing Address - Country:US
Mailing Address - Phone:818-718-9280
Mailing Address - Fax:818-718-9272
Practice Address - Street 1:8345 RESEDA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5952
Practice Address - Country:US
Practice Address - Phone:818-718-9280
Practice Address - Fax:818-718-9272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics