MEDICARE: DR. HALEY SUZANNE RITCHEY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DD1969	NM

General Provider Information

NPI Number	:	1851306591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HALEY SUZANNE RITCHEY D.D.S.

Provider Business Mailing Address
First Line	:	3491 TRINITY DR
Second Line	:	SUITE E
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2398
Country	:	US
Telephone Number	:	505-662-7786
Fax Number	:

Provider Business Practice Location Address
First Line	:	3491 TRINITY DR
Second Line	:	SUITE E
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2398
Country	:	US
Telephone Number	:	505-662-7786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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