Healthcare Provider Details

I. General information

NPI: 1922120146
Provider Name (Legal Business Name): NATHANIEL RITTER DDS, MSD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8769 N MAIN ST
DAYTON OH
45415-1331
US

IV. Provider business mailing address

8769 N MAIN ST
DAYTON OH
45415-1331
US

V. Phone/Fax

Practice location:
  • Phone: 937-890-9600
  • Fax: 937-890-9915
Mailing address:
  • Phone: 937-890-9600
  • Fax: 937-890-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.015795
License Number StateOH

VIII. Authorized Official

Name: DR. NATHANIEL RITTER
Title or Position: ORTHODONTIST
Credential: D.D.S.
Phone: 937-890-9600