Healthcare Provider Details

I. General information

NPI: 1942399175
Provider Name (Legal Business Name): JOHN M. RITTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E BROADWAY ST
FORTVILLE IN
46040-1551
US

IV. Provider business mailing address

6512 HIGHLAND LN
MC CORDSVILLE IN
46055-9533
US

V. Phone/Fax

Practice location:
  • Phone: 317-485-6477
  • Fax:
Mailing address:
  • Phone: 317-335-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8638A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: