Healthcare Provider Details

I. General information

NPI: 1235128687
Provider Name (Legal Business Name): DAVID BRUCE RITCHIE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 W SAINT CHARLES ST
SAN ANDREAS CA
95249-9664
US

IV. Provider business mailing address

PO BOX 501 1811 LOCKHART BLVD
MURPHYS CA
95247-0501
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-3816
  • Fax: 209-754-3818
Mailing address:
  • Phone: 209-728-3959
  • Fax: 209-728-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: