Healthcare Provider Details

I. General information

NPI: 1306824974
Provider Name (Legal Business Name): BRIAN KENNETH RITTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WEST AVENUE SUITE 230 NAVAL BRANCH CLINIC
SARATOGA SPRINGS NY
12866
US

IV. Provider business mailing address

ROUTE 12 NAVAL HEALTH CARE NEW ENGLAND GROTON BLDG 449 ATTN PROFESSIONAL AFFAIRS
GROTON CT
06349-5600
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-2377
  • Fax: 860-694-2590
Mailing address:
  • Phone: 860-694-2377
  • Fax: 860-694-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30 01 9445
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: